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NPI Code Detail

MEDICARE: MARIA FITZGIBBONS

MEDICARE: MARIA FITZGIBBONS
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
1163W00000XRegistered Nurse094733MO

General Provider Information

NPI Number : 1801330071
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIA FITZGIBBONS
Provider Business Mailing Address
First Line : 1601 OLD SOUTH RIVER RD
Second Line :
City : SAINT CHARLES
State : MO
Zip : 63303-4120
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1601 OLD SOUTH RIVER RD
Second Line :
City : SAINT CHARLES
State : MO
Zip : 63303-4120
Country : US
Telephone Number : 636-224-1230
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2016
Last Update Date : 12/07/2016

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Directions to “ MARIA FITZGIBBONS ” Practice Location

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