Provider Demographics
NPI:1316662265
Name:FITZGERALD, AMBER LEE
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:LEE
Last Name:FITZGERALD
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 1:1201 W RIVER RD N APT B3
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-2866
Mailing Address - Country:US
Mailing Address - Phone:440-453-3263
Mailing Address - Fax:
Practice Address - Street 1:1201 W RIVER RD N APT B3
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-2866
Practice Address - Country:US
Practice Address - Phone:440-453-3263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRL096092172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver