Provider Demographics
NPI:1033570387
Name:FITZGERALD, SCOTT (RN)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13626 PONDEROSA DR
Mailing Address - Street 2:
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433-5304
Mailing Address - Country:US
Mailing Address - Phone:303-906-9475
Mailing Address - Fax:
Practice Address - Street 1:421 ZANG ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1052
Practice Address - Country:US
Practice Address - Phone:303-989-4357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO99603163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent