Provider Demographics
NPI:1902901176
Name:BRITZ, LAURETTA M (FNP)
Entity Type:Individual
Prefix:
First Name:LAURETTA
Middle Name:M
Last Name:BRITZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 N OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-3011
Mailing Address - Country:US
Mailing Address - Phone:417-637-5133
Mailing Address - Fax:417-637-5124
Practice Address - Street 1:105 N. GRAND
Practice Address - Street 2:#2
Practice Address - City:GREENFIELD
Practice Address - State:MO
Practice Address - Zip Code:65661-0367
Practice Address - Country:US
Practice Address - Phone:417-637-5133
Practice Address - Fax:417-637-5124
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO142361363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily