Healthcare Provider Details

I. General information

NPI: 1396434114
Provider Name (Legal Business Name): LAURA DIANE FLETCHER BC-FNP, C-ENP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13733 N PRASADA PKWY STE 100
SURPRISE AZ
85388-8014
US

IV. Provider business mailing address

13733 N PRASADA PKWY STE 100
SURPRISE AZ
85388-8014
US

V. Phone/Fax

Practice location:
  • Phone: 623-444-7100
  • Fax:
Mailing address:
  • Phone: 843-492-1306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number322417
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number107622
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: