Provider Demographics
NPI:1477101079
Name:FITZPATRICK, ELIZABETH D
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:D
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 E ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50315-7748
Mailing Address - Country:US
Mailing Address - Phone:515-771-0550
Mailing Address - Fax:
Practice Address - Street 1:231 E ROSE AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50315-7748
Practice Address - Country:US
Practice Address - Phone:515-771-0550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0103421Medicaid