Provider Demographics
NPI:1669585949
Name:FITZGIBBON, JEANNE WHELAN (CRNP)
Entity type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:WHELAN
Last Name:FITZGIBBON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:
Other - Last Name:WHEALAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 PARK CENTER CT
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4201
Mailing Address - Country:US
Mailing Address - Phone:410-636-4900
Mailing Address - Fax:410-363-9426
Practice Address - Street 1:5 PARK CENTER CT
Practice Address - Street 2:SUITE 200
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4201
Practice Address - Country:US
Practice Address - Phone:410-636-4900
Practice Address - Fax:410-363-9426
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR045911207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD667LMedicare ID - Type Unspecified
R09046Medicare UPIN