Healthcare Provider Details

I. General information

NPI: 1912513763
Provider Name (Legal Business Name): HEATHER NICOLE FITZPATRICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2020
Last Update Date: 09/17/2020
Certification Date: 08/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 MEADOW CREEK DR STE 209
WESTMINSTER MD
21158-9455
US

IV. Provider business mailing address

1090 FRIDINGER MILL RD
WESTMINSTER MD
21157-3204
US

V. Phone/Fax

Practice location:
  • Phone: 301-829-1887
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR206524
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: