1619481744 NPI number — MS. NAN ISABEL FITZ GERALD RN CDE

Table of content: MS. NAN ISABEL FITZ GERALD RN CDE (NPI 1619481744)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619481744 NPI number — MS. NAN ISABEL FITZ GERALD RN CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FITZ GERALD
Provider First Name:
NAN
Provider Middle Name:
ISABEL
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN CDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FITZ GERALD
Provider Other First Name:
NAN
Provider Other Middle Name:
I.
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
087006811RN
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1619481744
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1040 NW 22ND AVE STE 540
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97210-3097
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-413-6077
Provider Business Mailing Address Fax Number:
503-413-6888

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1040 NW 22ND AVE STE 540
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97210-3097
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-413-6077
Provider Business Practice Location Address Fax Number:
503-413-6888
Provider Enumeration Date:
11/28/2017

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: 163WD0400X , with the licence number:  087006811RN , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com