MEDICARE: CONNIE JO FITZSIMMONS

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
1	101YS0200X	School Counselor		AZ

General Provider Information

NPI Number	:	1346434958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONNIE JO FITZSIMMONS

Provider Business Mailing Address
First Line	:	3404 N SANTA MARIA RD
Second Line	:
City	:	GOLDEN VALLEY
State	:	AZ
Zip	:	86413-9468
Country	:	US
Telephone Number	:	928-565-9111
Fax Number	:

Provider Business Practice Location Address
First Line	:	3404 N SANTA MARIA RD
Second Line	:
City	:	GOLDEN VALLEY
State	:	AZ
Zip	:	86413-9468
Country	:	US
Telephone Number	:	928-565-9111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2007
Last Update Date	:	08/29/2007

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