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NPI Code Detail

MEDICARE: CARRIE FITZSIMMONS NP

MEDICARE: CARRIE FITZSIMMONS NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner6353WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1111657OTHERNELICENSE

General Provider Information

NPI Number : 1033523584
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARRIE FITZSIMMONS NP
Provider Business Mailing Address
First Line : 270 MAIN ST N STE 300
Second Line :
City : STILLWATER
State : MN
Zip : 55082-6788
Country : US
Telephone Number : 651-342-1039
Fax Number : 651-342-1428
Provider Business Practice Location Address
First Line : 342 N WATER ST STE 600
Second Line :
City : MILWAUKEE
State : WI
Zip : 53202-5715
Country : US
Telephone Number : 651-342-1039
Fax Number : 651-342-1428
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2014
Last Update Date : 05/04/2026

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