Basic Information
| Provider Information | |||||||||
| NPI: | 1386667830 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FITZSIMMONS | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | MINTERN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 165 N VILLAGE AVE | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | ROCKVILLE CENTRE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115703761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167645380 | ||||||||
| FaxNumber: | 5167641915 | ||||||||
| Practice Location | |||||||||
| Address1: | 165 N VILLAGE AVE | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | ROCKVILLE CENTRE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115703761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5167645380 | ||||||||
| FaxNumber: | 5167641915 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 07/27/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 000118 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.