Provider Demographics
NPI:1316515950
Name:FRITTS, RENHONG
Entity type:Individual
Prefix:
First Name:RENHONG
Middle Name:
Last Name:FRITTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10109 E 79TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-4564
Mailing Address - Country:US
Mailing Address - Phone:918-728-3354
Mailing Address - Fax:918-728-7554
Practice Address - Street 1:10109 E 79TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-4564
Practice Address - Country:US
Practice Address - Phone:918-728-3354
Practice Address - Fax:918-728-7554
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4884363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical