Basic Information
| Provider Information | |||||||||
| NPI: | 1558321794 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRANTZICH | ||||||||
| FirstName: | CARRIE | ||||||||
| MiddleName: | JAYNE ROTH | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11575 PALISADE AVE N | ||||||||
| Address2: | |||||||||
| City: | STILLWATER | ||||||||
| State: | MN | ||||||||
| PostalCode: | 550823409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6513515431 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1875 WOODWINDS DR | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551252298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512326700 | ||||||||
| FaxNumber: | 6512326711 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 176B00000X | R123364-3 | MN | Y | Other Service Providers | Midwife |
No ID Information.