Healthcare Provider Details

I. General information

NPI: 1649283060
Provider Name (Legal Business Name): HEIDI LOUISE FLETEMIER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 SKYLINE VILLAGE LOOP S
SALEM OR
97306-9490
US

IV. Provider business mailing address

PO BOX 13490
SALEM OR
97309-1490
US

V. Phone/Fax

Practice location:
  • Phone: 503-391-1110
  • Fax: 503-370-4237
Mailing address:
  • Phone: 503-391-1110
  • Fax: 503-370-4237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD26003
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: