Provider Demographics
NPI:1790728640
Name:FITZPATRICK, MAUREEN ANNE (CRNP)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:ANNE
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 LOCH RAVEN BLVD
Mailing Address - Street 2:VAMC - HBPC
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-2108
Mailing Address - Country:US
Mailing Address - Phone:410-605-7620
Mailing Address - Fax:410-605-7676
Practice Address - Street 1:3900 LOCH RAVEN BLVD
Practice Address - Street 2:VAMC - HBPC
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2108
Practice Address - Country:US
Practice Address - Phone:410-605-7620
Practice Address - Fax:410-605-7676
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR126860363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD404180100Medicaid
MDH897I074OtherPROVIDER NUMBER
MD404180100Medicaid