Provider Demographics
NPI:1154133072
Name:FITZGIBBONS, KAREN DALE
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:DALE
Last Name:FITZGIBBONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 S 128TH PLZ
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2172
Mailing Address - Country:US
Mailing Address - Phone:402-670-2406
Mailing Address - Fax:
Practice Address - Street 1:3419 S 94TH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2750
Practice Address - Country:US
Practice Address - Phone:402-981-2831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child