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Individual
KEVIN FITZGERALD
Active
Individual
KEVIN FITZGERALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704305891
MI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
4704305891
MI
Other
Enumeration date
01/23/2018
Last updated
02/20/2019
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