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General NPI Number Information
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NPI Number | 1992049209
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Entity Type | Individual
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Provider Name | RENEE ANTONETTE FLETCHER CRNP FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/27/2012
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Last Update Date | 06/29/2022
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Provider Practice Location Address
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Address Line | 1401 PULASKI HWY STE W
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City | EDGEWOOD
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State | MD
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Zip | 21040-1398
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Country | US
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Telephone | 410-671-6900
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Fax | 410-671-6901
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Provider Business Mailing Address
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Address Line | 1401 PULASKI HWY STE W
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City | EDGEWOOD
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State | MD
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Zip | 21040-1398
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Country | US
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Telephone | 104-671-6900
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Fax | 410-671-6901
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R199709
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License Number State | MD
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