MEDICARE: MRS. LAURIE ANN FITCH R.N.

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	400375-1	NY

General Provider Information

NPI Number	:	1891865028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURIE ANN FITCH R.N.

Provider Business Mailing Address
First Line	:	210 SEITZ DR
Second Line	:
City	:	CAMILLUS
State	:	NY
Zip	:	13031-1831
Country	:	US
Telephone Number	:	315-468-1550
Fax Number	:

Provider Business Practice Location Address
First Line	:	228 LAFAYETTE RD
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13205-2921
Country	:	US
Telephone Number	:	315-492-9990
Fax Number	:

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

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	07/08/2007

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