Provider Demographics
NPI:1427400910
Name:FRUCHTNICHT, MARIE PEASE (LAC)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:PEASE
Last Name:FRUCHTNICHT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2539 S GESSNER RD STE 15
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-2028
Mailing Address - Country:US
Mailing Address - Phone:713-922-8179
Mailing Address - Fax:
Practice Address - Street 1:2539 S GESSNER RD STE 15
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-2028
Practice Address - Country:US
Practice Address - Phone:713-922-8179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXACO1479171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist