Provider Demographics
NPI:1861469736
Name:FITZGERALD, MICHELLE D (FNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:D
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 NORTH ST
Mailing Address - Street 2:MGHA HOSPITALIST PROGRAM-WTVL
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901
Mailing Address - Country:US
Mailing Address - Phone:207-872-1000
Mailing Address - Fax:
Practice Address - Street 1:149 NORTH ST
Practice Address - Street 2:MGHA HOSPITALIST PROGRAM-WTVL
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901
Practice Address - Country:US
Practice Address - Phone:207-872-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP81416363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME240130099Medicaid
MES31960Medicare UPIN
ME240130099Medicaid
MENP0700Medicare PIN
MENP070001Medicare PIN