Provider Demographics
NPI:1477964666
Name:FITZGERALD, CHARLOTTE
Entity Type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PURPLE EMPIRE
Other - Middle Name:
Other - Last Name:IN HOME CARE AGENCY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2074 BENNOCH RD
Mailing Address - Street 2:
Mailing Address - City:OLD TOWN
Mailing Address - State:ME
Mailing Address - Zip Code:04468-5610
Mailing Address - Country:US
Mailing Address - Phone:207-356-3054
Mailing Address - Fax:207-817-0197
Practice Address - Street 1:2074 BENNOCH RD
Practice Address - Street 2:
Practice Address - City:OLD TOWN
Practice Address - State:ME
Practice Address - Zip Code:04468-5610
Practice Address - Country:US
Practice Address - Phone:207-356-3054
Practice Address - Fax:207-817-0197
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-11
Last Update Date:2015-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker