Provider Demographics
NPI:1528333697
Name:FITZWATER, LYNN MARY (RN BSN)
Entity type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:MARY
Last Name:FITZWATER
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6484 TEAKWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45224-2110
Mailing Address - Country:US
Mailing Address - Phone:513-541-4403
Mailing Address - Fax:
Practice Address - Street 1:6484 TEAKWOOD CT
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45224
Practice Address - Country:US
Practice Address - Phone:513-541-4403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNS.15158364SA2200X
OH15158364SA2200X
OHRN 326873163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health