MEDICARE: MRS. HOLLY FITZGERALD RN

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
1	163WS0200X	School Registered Nurse	378176-1	NY

General Provider Information

NPI Number	:	1225307564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HOLLY FITZGERALD RN

Provider Business Mailing Address
First Line	:	6050 FAIRWAY CT
Second Line	:
City	:	LAKE VIEW
State	:	NY
Zip	:	14085-9568
Country	:	US
Telephone Number	:	716-926-1770
Fax Number	:	716-926-1755

Provider Business Practice Location Address
First Line	:	6050 FAIRWAY CT
Second Line	:
City	:	LAKE VIEW
State	:	NY
Zip	:	14085-9568
Country	:	US
Telephone Number	:	716-926-1770
Fax Number	:	716-926-1755

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2011
Last Update Date	:	12/15/2011

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