Provider Demographics
NPI:1700239910
Name:FITZSIMMONS, VICKI L (RN)
Entity Type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:L
Last Name:FITZSIMMONS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N7354 COUNTY ROAD A
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53038-9737
Mailing Address - Country:US
Mailing Address - Phone:920-699-3514
Mailing Address - Fax:920-699-3514
Practice Address - Street 1:N7354 COUNTY ROAD A
Practice Address - Street 2:
Practice Address - City:JOHNSON CREEK
Practice Address - State:WI
Practice Address - Zip Code:53038-9737
Practice Address - Country:US
Practice Address - Phone:920-699-3514
Practice Address - Fax:920-699-3514
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI190858-30163W00000X
IL041283255163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse