Provider Demographics
NPI:1992911275
Name:FRITZ, JO BETH (RN)
Entity type:Individual
Prefix:MS
First Name:JO
Middle Name:BETH
Last Name:FRITZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 ROAD 2900
Mailing Address - Street 2:
Mailing Address - City:AZTEC
Mailing Address - State:NM
Mailing Address - Zip Code:87410-1040
Mailing Address - Country:US
Mailing Address - Phone:505-664-3405
Mailing Address - Fax:505-634-3413
Practice Address - Street 1:520 N 1ST ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NM
Practice Address - Zip Code:87413-5307
Practice Address - Country:US
Practice Address - Phone:505-634-3405
Practice Address - Fax:505-634-3413
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR 22079163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM64434826Medicaid