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General NPI Number Information
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NPI Number | 1477652238
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Entity Type | Individual
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Provider Name | WENDY LEE FITZGERALD RN CRNP FAMILY NURSE
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Gender | Female
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12417 OCEAN GATEWAY HERRING CREEK PROFESSIONAL CENTER BLDG A SUITE 5
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City | OCEAN CITY
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State | MD
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Zip | 21842
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Country | US
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Telephone | 410-213-0111
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Fax | 410-213-8459
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Provider Business Mailing Address
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Address Line | 10635 SHADY DRIVE
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City | BERLIN
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State | MD
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Zip | 21811
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Country | US
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Telephone | 410-641-9007
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R104225
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP104225
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License Number State | MD
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