Provider Demographics
NPI:1134877467
Name:FITZPATRICK, TERESA MICHELE (COSMETOLOGIST)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:MICHELE
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:COSMETOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 S PENN ST
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47302-2559
Mailing Address - Country:US
Mailing Address - Phone:765-372-8072
Mailing Address - Fax:
Practice Address - Street 1:815 S PENN ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47302-2559
Practice Address - Country:US
Practice Address - Phone:765-372-8072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INBC20705312174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist