Provider Demographics
NPI:1629355524
Name:FITZSIMMONS, KARA-JEAN (LPN)
Entity Type:Individual
Prefix:MS
First Name:KARA-JEAN
Middle Name:
Last Name:FITZSIMMONS
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 1:1 WINNERMERE CIR
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-1127
Mailing Address - Country:US
Mailing Address - Phone:585-329-1790
Mailing Address - Fax:
Practice Address - Street 1:1 WINNERMERE CIR
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-1127
Practice Address - Country:US
Practice Address - Phone:585-329-1790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292478-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse