Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | ||
N | 224P00000X | Prosthetist | 224P00000X | VA |
NPI | 1114358496 |
---|---|
Provider Name | Jimeka Fitzgerald |
First Address | Portsmouth, VA 23705-0192 |
Second Address | Portsmouth, VA 23701-4203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2013 |
Last Update Date | 11/12/2013 |