Provider Demographics
NPI:1295839355
Name:FITZPATRICK, LAURA A (NP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7689 SAGAMORE HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:SAGAMORE HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44067-2960
Mailing Address - Country:US
Mailing Address - Phone:330-467-8101
Mailing Address - Fax:330-468-3948
Practice Address - Street 1:7689 SAGAMORE HILLS BLVD
Practice Address - Street 2:
Practice Address - City:SAGAMORE HILLS
Practice Address - State:OH
Practice Address - Zip Code:44067-2960
Practice Address - Country:US
Practice Address - Phone:330-467-8101
Practice Address - Fax:330-468-3948
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY333617363LF0000X
OHNP10002363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily