Healthcare Provider Details

I. General information

NPI: 1295839355
Provider Name (Legal Business Name): LAURA A FITZPATRICK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7689 SAGAMORE HILLS BLVD
SAGAMORE HILLS OH
44067-2960
US

IV. Provider business mailing address

7689 SAGAMORE HILLS BLVD
SAGAMORE HILLS OH
44067-2960
US

V. Phone/Fax

Practice location:
  • Phone: 330-467-8101
  • Fax: 330-468-3948
Mailing address:
  • Phone: 330-467-8101
  • Fax: 330-468-3948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number333617
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP10002
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: