MEDICARE: MS. JESSICA MARIE FITZHUGH LPN

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	164W00000X	Licensed Practical Nurse	PN132109-IV	OH
2	172A00000X	Driver	RN721582	OH

General Provider Information

NPI Number	:	1760783625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSICA MARIE FITZHUGH LPN

Provider Business Mailing Address
First Line	:	122 TWIN LAKES DR
Second Line	:
City	:	FAIRFIELD
State	:	OH
Zip	:	45014-5255
Country	:	US
Telephone Number	:	513-834-3488
Fax Number	:

Provider Business Practice Location Address
First Line	:	122 TWIN LAKES DR
Second Line	:
City	:	FAIRFIELD
State	:	OH
Zip	:	45014-5255
Country	:	US
Telephone Number	:	513-834-3488
Fax Number	:

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

Provider Enumeration Date	:	11/09/2010
Last Update Date	:	07/20/2022

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