Provider Demographics
NPI:1477652238
Name:FITZGERALD, WENDY LEE (RN CRNP FAMILY NURSE)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:LEE
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:RN CRNP FAMILY NURSE
Other - Prefix:MRS
Other - First Name:WENDY
Other - Middle Name:LEE
Other - Last Name:MACWHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10635 SHADY DRIVE
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811
Mailing Address - Country:US
Mailing Address - Phone:410-641-9007
Mailing Address - Fax:
Practice Address - Street 1:12417 OCEAN GATEWAY
Practice Address - Street 2:HERRING CREEK PROFESSIONAL CENTER BLDG A SUITE 5
Practice Address - City:OCEAN CITY
Practice Address - State:MD
Practice Address - Zip Code:21842
Practice Address - Country:US
Practice Address - Phone:410-213-0111
Practice Address - Fax:410-213-8459
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR104225363L00000X
MDNP104225363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
F6200002OtherBCBS
P33864Medicare UPIN
F6200002OtherBCBS