Healthcare Provider Details

I. General information

NPI: 1528333697
Provider Name (Legal Business Name): LYNN MARY FITZWATER RN BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 05/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6484 TEAKWOOD CT
CINCINNATI OH
45224
US

IV. Provider business mailing address

6484 TEAKWOOD CT
CINCINNATI OH
45224-2110
US

V. Phone/Fax

Practice location:
  • Phone: 513-541-4403
  • Fax:
Mailing address:
  • Phone: 513-541-4403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberAPRN.CNS.15158
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number15158
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 326873
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: