Basic Information
| Provider Information | |||||||||
| NPI: | 1609811611 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FITZPATRICK | ||||||||
| FirstName: | DOREEN | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MSN APN C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 593 | ||||||||
| Address2: | |||||||||
| City: | CAPE MAY COURT HOUSE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082100593 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094652273 | ||||||||
| FaxNumber: | 6094630235 | ||||||||
| Practice Location | |||||||||
| Address1: | 11 VILLAGE DR | ||||||||
| Address2: | |||||||||
| City: | CAPE MAY COURT HOUSE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082101939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094652273 | ||||||||
| FaxNumber: | 6094630235 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2006 | ||||||||
| LastUpdateDate: | 02/14/2013 | ||||||||
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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 | 363L00000X | NN08226000 | NJ | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LA2200X | NN08226000 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 0002593 | 05 | NJ | MEDICAID |