Provider Demographics
NPI:1164454021
Name:FITZGERALD, MARILYN E (CRNP)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:E
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MS
Other - First Name:MARILYN
Other - Middle Name:E
Other - Last Name:KLEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1803 MOUNT ROSE AVE
Mailing Address - Street 2:SUITE B3
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3026
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-851-6969
Practice Address - Street 1:290 ST. CHARLES WAY
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402
Practice Address - Country:US
Practice Address - Phone:717-851-5503
Practice Address - Fax:717-851-5978
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP004276B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1551705OtherGATEWAY-WMG
MD621272OtherCAREFIRST MD BCBS
PA106216OtherJOHNS HOPKINS
PA20027900OtherAMERIHEALTH MERCY-WMG
PA1933957OtherHIGHMARK BLUE SHIELD
PA50023730OtherCAPITAL BLUE CROSS-WMG
PA50023730OtherCAPITAL BLUE CROSS-WMG
PA1551705OtherGATEWAY-WMG