1154686608 NPI number — MRS. MEGAN J FITZPATRICK ANP-BC. M.S.

Table of content: MRS. MEGAN J FITZPATRICK ANP-BC. M.S. (NPI 1154686608)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154686608 NPI number — MRS. MEGAN J FITZPATRICK ANP-BC. M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FITZPATRICK
Provider First Name:
MEGAN
Provider Middle Name:
J
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ANP-BC. M.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MULDER
Provider Other First Name:
MEGAN
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
ANP-BC. M.S.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1154686608
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1900 44TH ST SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENTWOOD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49508-5008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 LAFAYETTE AVE SE
Provider Second Line Business Practice Location Address:
STE 2045
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49503-4692
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-685-3098
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/11/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  4704254066 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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