MEDICARE: SORAYA DINARI FLETCHER NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	638551	TX

General Provider Information

NPI Number	:	1427035245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SORAYA DINARI FLETCHER NP

Provider Business Mailing Address
First Line	:	600 PARTRIDGE DR
Second Line	:
City	:	ARGYLE
State	:	TX
Zip	:	76226-5118
Country	:	US
Telephone Number	:	940-464-2005
Fax Number	:

Provider Business Practice Location Address
First Line	:	1830 BLAKE AVE
Second Line	:
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-4275
Country	:	US
Telephone Number	:	970-945-8503
Fax Number	:	970-945-0253

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	05/07/2019

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