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General NPI Number Information
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NPI Number | 1346503273
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Entity Type | Individual
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Provider Name | LISA MARIE FITZGERALD PNP
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Gender | Female
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Dates
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Enumeration Date | 06/15/2012
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Last Update Date | 06/15/2012
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Provider Practice Location Address
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Address Line | 200 NORTH ST SUITE 101
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City | GENEVA
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State | NY
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Zip | 14456-1561
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Country | US
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Telephone | 315-787-5200
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Fax | 315-787-5221
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Provider Business Mailing Address
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Address Line | 200 NORTH ST SUITE 101
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City | GENEVA
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State | NY
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Zip | 14456-1561
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Country | US
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Telephone | 315-787-5200
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Fax | 315-787-5221
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | F382288
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License Number State | NY
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