Healthcare Provider Details

I. General information

NPI: 1598740516
Provider Name (Legal Business Name): ANNE M FITZPATRICK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 S 73RD ST SUITE 402
OMAHA NE
68124-2396
US

IV. Provider business mailing address

2420 S 73RD ST SUITE 402
OMAHA NE
68124-2396
US

V. Phone/Fax

Practice location:
  • Phone: 402-397-1654
  • Fax: 402-397-7926
Mailing address:
  • Phone: 402-397-1654
  • Fax: 402-397-7926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number22116
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: