Provider Demographics
NPI:1104027671
Name:FITZGERALD, MARTHA DRAKE (RN, FNP,)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:DRAKE
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:RN, FNP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-1942
Mailing Address - Country:US
Mailing Address - Phone:541-482-1038
Mailing Address - Fax:
Practice Address - Street 1:1005 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7448
Practice Address - Country:US
Practice Address - Phone:541-774-8209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR087006747N1FNP-PP207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine