MEDICARE: JESSICA FITZPATRICK RN

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	163W00000X	Registered Nurse	22543445	NY
2	163W00000X	Registered Nurse	26NR16354300	NJ

General Provider Information

NPI Number	:	1811372949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA FITZPATRICK RN

Provider Business Mailing Address
First Line	:	11127 75TH RD
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-6307
Country	:	US
Telephone Number	:	573-489-8290
Fax Number	:

Provider Business Practice Location Address
First Line	:	11127 75TH RD
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-6307
Country	:	US
Telephone Number	:	573-489-8290
Fax Number	:

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

Provider Enumeration Date	:	07/30/2015
Last Update Date	:	07/30/2015

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