Provider Demographics
NPI:1538701602
Name:FITZPATRICK, JENNIFER (LPN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 COUNTY HOUSE WOODS RD
Mailing Address - Street 2:
Mailing Address - City:BLUFF POINT
Mailing Address - State:NY
Mailing Address - Zip Code:14478-9711
Mailing Address - Country:US
Mailing Address - Phone:315-759-9437
Mailing Address - Fax:
Practice Address - Street 1:2600 COUNTY HOUSE WOODS RD
Practice Address - Street 2:
Practice Address - City:BLUFF POINT
Practice Address - State:NY
Practice Address - Zip Code:14478-9711
Practice Address - Country:US
Practice Address - Phone:315-759-9437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY327809164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse