Provider Demographics
NPI:1497097976
Name:FITZWILLIAM, NIGEL (LPN)
Entity Type:Individual
Prefix:MR
First Name:NIGEL
Middle Name:
Last Name:FITZWILLIAM
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WOODS RD
Mailing Address - Street 2:
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1529
Mailing Address - Country:US
Mailing Address - Phone:914-231-1000
Mailing Address - Fax:
Practice Address - Street 1:10 WOODS RD
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1529
Practice Address - Country:US
Practice Address - Phone:914-231-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-22
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270591-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse