Healthcare Provider Details

I. General information

NPI: 1922263201
Provider Name (Legal Business Name): LENEIR SHAMARA FLETCHER RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 07/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5959 PARK AVE
MEMPHIS TN
38119-5200
US

IV. Provider business mailing address

4272 LANSFORD DR
MEMPHIS TN
38128-3311
US

V. Phone/Fax

Practice location:
  • Phone: 901-765-1245
  • Fax:
Mailing address:
  • Phone: 901-385-8013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number0000003993
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: