Provider Demographics
NPI:1013142330
Name:FITZPATRICK, LORITHA ANN (CPM, LM)
Entity type:Individual
Prefix:MRS
First Name:LORITHA
Middle Name:ANN
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8522 OLD OLYMPIC HWY
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-6812
Mailing Address - Country:US
Mailing Address - Phone:843-254-5435
Mailing Address - Fax:
Practice Address - Street 1:8522 OLD OLYMPIC HWY
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-6812
Practice Address - Country:US
Practice Address - Phone:843-254-5435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW60130114176B00000X
SCLMW-0041367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNM0039Medicaid
AKAK3516OtherOR DEPT. OF HEALTH NEWBORN SCREENING