Basic Information
| Provider Information | |||||||||
| NPI: | 1477914638 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRITZ | ||||||||
| FirstName: | SHAUN | ||||||||
| MiddleName: | TOMPKINS | ||||||||
| NamePrefix: | |||||||||
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| Credential: | CPNP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | TOMPKINS | ||||||||
| OtherFirstName: | SHAUN | ||||||||
| OtherMiddleName: | MARIE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | RN | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 509 POWELL DR | ||||||||
| Address2: | |||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214016526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4439941824 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 200 FORBES ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214011538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102636363 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2016 | ||||||||
| LastUpdateDate: | 03/16/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | R213857 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.