Provider Demographics
NPI:1679307532
Name:FITZPATRICK, MINDY MARIE (MSN, RN, PHN)
Entity type:Individual
Prefix:MRS
First Name:MINDY
Middle Name:MARIE
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:MSN, RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31861 VICTORIA PL
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-4944
Mailing Address - Country:US
Mailing Address - Phone:760-222-7331
Mailing Address - Fax:
Practice Address - Street 1:41549 KALMIA ST
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-9597
Practice Address - Country:US
Practice Address - Phone:760-996-4841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-31
Last Update Date:2024-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA839549163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse