Basic Information
Provider Information
NPI: 1447844055
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FRITZ
FirstName: SARAH
MiddleName: ELIZABETH
NamePrefix:  
NameSuffix:  
Credential: RDN, LDN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6701 AIRPORT BLVD STE A101
Address2:  
City: MOBILE
State: AL
PostalCode: 366086767
CountryCode: US
TelephoneNumber: 2516338880
FaxNumber:  
Practice Location
Address1: 6701 AIRPORT BLVD STE A101
Address2:  
City: MOBILE
State: AL
PostalCode: 366086767
CountryCode: US
TelephoneNumber: 2516338880
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/24/2021
LastUpdateDate: 02/24/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/24/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
133VN1201X3110ALY    

No ID Information.


Home