Provider Demographics
NPI:1043450182
Name:FLETCHER, NANCY LYNN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:LYNN
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51
Mailing Address - Street 2:
Mailing Address - City:EAST BRANCH
Mailing Address - State:NY
Mailing Address - Zip Code:13756-0051
Mailing Address - Country:US
Mailing Address - Phone:607-363-7636
Mailing Address - Fax:
Practice Address - Street 1:202 SIGNOR RD
Practice Address - Street 2:
Practice Address - City:EAST BRANCH
Practice Address - State:NY
Practice Address - Zip Code:13756
Practice Address - Country:US
Practice Address - Phone:845-707-9535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY293764-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse