Provider Demographics
NPI:1457099285
Name:FITZGERALD, JENNIFER C (RN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:C
Other - Last Name:RAWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1328 FOREST CIR
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-5444
Mailing Address - Country:US
Mailing Address - Phone:651-398-3298
Mailing Address - Fax:
Practice Address - Street 1:1328 FOREST CIR
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-5444
Practice Address - Country:US
Practice Address - Phone:651-398-3298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-1606720-0163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse