MEDICARE: YVONNE FITZWILLIAMS

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	374K00000X	Religious Nonmedical Practitioner

General Provider Information

NPI Number	:	1225753213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YVONNE FITZWILLIAMS

Provider Business Mailing Address
First Line	:	1230 W SPRING VALLEY RD
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75080-7709
Country	:	US
Telephone Number	:	972-890-3427
Fax Number	:

Provider Business Practice Location Address
First Line	:	1230 W SPRING VALLEY RD
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75080-7709
Country	:	US
Telephone Number	:	972-643-3523
Fax Number	:	972-643-3500

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

Provider Enumeration Date	:	10/11/2022
Last Update Date	:	10/11/2022

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