Provider Demographics
NPI:1619942588
Name:FITZGERALD, MAURA (CNS)
Entity Type:Individual
Prefix:
First Name:MAURA
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:CNS
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Mailing Address - Street 1:2910 CENTRE POINTE DRIVE
Mailing Address - Street 2:35 121A CHILDRENS HEALTH CARE
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113
Mailing Address - Country:US
Mailing Address - Phone:651-855-2109
Mailing Address - Fax:651-855-2310
Practice Address - Street 1:2525 CHICAGO AVENUE SOUTH
Practice Address - Street 2:CHILDRENS SPECIALTY CLINIC INTEGRATIVE MEDICINE MPLS
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404
Practice Address - Country:US
Practice Address - Phone:612-813-7997
Practice Address - Fax:612-813-7199
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MNR0802800364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist