Individual
LAURIE JEAN FITZGIBBON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C, CCNS
Contact information
Practice address
1330 MERCY DR NW, SUITE 418, CANTON, OH 44708-2626
(330) 489-1454
Mailing address
PO BOX 932100, CLEVELAND, OH 44193-0008
(216) 472-2730
(216) 472-2740
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
COA.18318-NP
OH
364SA2100X
Acute Care Clinical Nurse Specialist
COA.10052-NS
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0152995
—
OH
Enumeration date
12/17/2015
Last updated
01/06/2016
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