Healthcare Provider Details

I. General information

NPI: 1790223485
Provider Name (Legal Business Name): SHERRY ANN FLETCHER L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 02/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 FOOTHILLS RD L 18
LAS CRUCES NM
88011-8657
US

IV. Provider business mailing address

3500 FOOTHILLS RD L 18
LAS CRUCES NM
88011-8657
US

V. Phone/Fax

Practice location:
  • Phone: 575-312-7479
  • Fax:
Mailing address:
  • Phone: 575-312-7479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7975
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: