Provider Demographics
NPI:1821081092
Name:FITZPATRICK, MARY A (ARNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1034, P3NEURO
Mailing Address - Street 2:DEPT. OF VA MEDICAL CENTER, PORTLAND
Mailing Address - City:POTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97207-1034
Mailing Address - Country:US
Mailing Address - Phone:503-220-8262
Mailing Address - Fax:503-721-1048
Practice Address - Street 1:3710 SW US VETERANS HOSPITAL RD
Practice Address - Street 2:DEPT. OF VA MEDICAL CENTER, PORTLAND
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97207-1034
Practice Address - Country:US
Practice Address - Phone:503-220-8262
Practice Address - Fax:503-220-8262
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9642240Medicaid
WA9642240Medicaid
8850365Medicare ID - Type Unspecified