Provider Demographics
NPI:1215294707
Name:FITZMAURICE, DAWN (RN)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:
Last Name:FITZMAURICE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6699 HAMLET AVE
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:WI
Mailing Address - Zip Code:54656-3420
Mailing Address - Country:US
Mailing Address - Phone:608-487-4447
Mailing Address - Fax:
Practice Address - Street 1:6699 HAMLET AVE
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:WI
Practice Address - Zip Code:54656-3420
Practice Address - Country:US
Practice Address - Phone:608-487-4447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI170343-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse