Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 5014111 | NC |
NPI | 1285227553 |
---|---|
Provider Name | Kathleen Perry Fitzgerald |
First Address | Winston Salem, NC 27106-4574 |
Second Address | Winston Salem, NC 27157-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2021 |
Last Update Date | 17/02/2021 |