=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891787412
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICIA GAIL FITCH FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | G2138 W CARPENTER RD
-----------------------------------------------------
City | FLINT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48505-1977
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-760-5076
-----------------------------------------------------
Fax | 810-760-5072
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4730 HOWLAND RD
-----------------------------------------------------
City | ALMONT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48003-8521
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 810-798-3134
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 4704083993
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------