Provider Demographics
NPI:1821837956
Name:FITZPATRICK, REBECCA CARSON
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:CARSON
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 KAHLER RD
Mailing Address - Street 2:
Mailing Address - City:PEMBERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43450-9664
Mailing Address - Country:US
Mailing Address - Phone:419-266-2746
Mailing Address - Fax:
Practice Address - Street 1:1624 KAHLER RD
Practice Address - Street 2:
Practice Address - City:PEMBERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43450-9664
Practice Address - Country:US
Practice Address - Phone:419-266-2746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No172A00000XOther Service ProvidersDriver
No376J00000XNursing Service Related ProvidersHomemaker