Provider Demographics
NPI:1386667830
Name:FITZSIMMONS, ELIZABETH MINTERN (CNM)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MINTERN
Last Name:FITZSIMMONS
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Gender:F
Credentials:CNM
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Mailing Address - Street 1:165 N VILLAGE AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3761
Mailing Address - Country:US
Mailing Address - Phone:516-764-5380
Mailing Address - Fax:516-764-1915
Practice Address - Street 1:165 N VILLAGE AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3761
Practice Address - Country:US
Practice Address - Phone:516-764-5380
Practice Address - Fax:516-764-1915
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2012-07-27
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Provider Licenses
StateLicense IDTaxonomies
NY000118367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife