Provider Demographics
NPI:1063833762
Name:FLETCHER, MARLO (CRNP)
Entity Type:Individual
Prefix:
First Name:MARLO
Middle Name:
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 SUMMIT AVE
Mailing Address - Street 2:MSO PHYSICIAN BILLING
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2667
Mailing Address - Country:US
Mailing Address - Phone:740-283-1100
Mailing Address - Fax:740-314-8614
Practice Address - Street 1:1524 SUNSET BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-1380
Practice Address - Country:US
Practice Address - Phone:740-283-1100
Practice Address - Fax:740-314-8614
Is Sole Proprietor?:No
Enumeration Date:2013-12-23
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.15086363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810026947Medicaid
OH0096118Medicaid
OHH256710Medicare PIN