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General NPI Number Information
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NPI Number | 1104223544
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Entity Type | Individual
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Provider Name | TAMMY FLETCHER NP
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Gender | Female
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Dates
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Enumeration Date | 12/01/2014
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Last Update Date | 02/21/2020
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Provider Practice Location Address
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Address Line | 1841 N PERRY
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City | PONTIAC
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State | MI
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Zip | 48340
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Country | US
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Telephone | 248-377-2673
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Fax |
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Provider Business Mailing Address
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Address Line | 38855 HILLS TECH DR SUITE 200
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City | FARMINGTON HILLS
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State | MI
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Zip | 48331
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Country | US
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Telephone | 248-871-1495
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Fax | 248-994-4655
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704213030
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | L2394237
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4704213030
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License Number State | MI
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