Individual
MARY FITZGERALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1906 BELLEVIEW AVE SE, ROANOKE, VA 24014-1838
(540) 981-7000
Mailing address
416 HIGH ST, SALEM, VA 24153-3946
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
0001-052910
VA
367500000X
Certified Registered Nurse Anesthetist
0024-052910
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8940631
—
VA
05
—
8940649
—
VA
05
—
8940657
—
VA
05
—
8940711
—
VA
05
—
8940720
—
VA
Enumeration date
04/25/2006
Last updated
10/28/2008
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