Provider Demographics
NPI:1821597337
Name:FITZGERALD, ELLEN M (BSN, RN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:M
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:BSN, RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 LONGWATER DR
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-1867
Mailing Address - Country:US
Mailing Address - Phone:781-635-6479
Mailing Address - Fax:
Practice Address - Street 1:152 LONGWATER DR
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-1867
Practice Address - Country:US
Practice Address - Phone:781-635-6479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-10
Last Update Date:2018-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA258746163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant