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NPI Code Detail

MEDICARE: MRS. MARY G FITZGERALD ANP

MEDICARE: MRS. MARY G FITZGERALD ANP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0200XPediatric Nurse Practitioner065417MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033224472
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARY G FITZGERALD ANP
Provider Business Mailing Address
First Line : 6121 N HANLEY RD
Second Line :
City : BERKELEY
State : MO
Zip : 63134-2003
Country : US
Telephone Number : 314-615-0600
Fax Number : 314-615-8303
Provider Business Practice Location Address
First Line : 6121 N HANLEY RD
Second Line :
City : BERKELEY
State : MO
Zip : 63134-2003
Country : US
Telephone Number : 314-615-0600
Fax Number : 314-615-8303
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2006
Last Update Date : 09/25/2012

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