Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | FITZ-17X2Y | NC |
NPI | 1043987852 |
---|---|
Provider Name | Leah Christine Fitzgerald |
First Address | Swansboro, NC 28584-8491 |
Second Address | Raleigh, NC 28617 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2021 |
Last Update Date | 06/10/2021 |