Provider Demographics
NPI:1477839637
Name:FITTS, MARIE (RN, MSN, CNS)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:FITTS
Suffix:
Gender:F
Credentials:RN, MSN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5342 DUDLEY BLVD BLDG 98
Mailing Address - Street 2:
Mailing Address - City:MCCLELLAN
Mailing Address - State:CA
Mailing Address - Zip Code:95652-1012
Mailing Address - Country:US
Mailing Address - Phone:916-561-7520
Mailing Address - Fax:916-561-7529
Practice Address - Street 1:5342 DUDLEY BLVD BLDG 98
Practice Address - Street 2:
Practice Address - City:MCCLELLAN
Practice Address - State:CA
Practice Address - Zip Code:95652-1012
Practice Address - Country:US
Practice Address - Phone:916-561-7520
Practice Address - Fax:916-561-7529
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-35431163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse