Provider Demographics
NPI:1598468431
Name:FITZPATRICK, SHANNON CATHERINE (RN)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:CATHERINE
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 EAST RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:ME
Mailing Address - Zip Code:04349-3135
Mailing Address - Country:US
Mailing Address - Phone:207-232-2260
Mailing Address - Fax:
Practice Address - Street 1:22 BRAMHALL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3175
Practice Address - Country:US
Practice Address - Phone:207-662-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-22
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERNA233046367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered