Provider Demographics
NPI:1114438439
Name:FLETCHER, AMY MARIE (BSN, RN, MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:BSN, RN, MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 UNION ST
Mailing Address - Street 2:
Mailing Address - City:GLASSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08028-5100
Mailing Address - Country:US
Mailing Address - Phone:856-279-3145
Mailing Address - Fax:
Practice Address - Street 1:415 W LANDIS AVE STE 102
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-8135
Practice Address - Country:US
Practice Address - Phone:888-985-2727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-12
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26N012220700163WI0500X
NJ26NJ00779600363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8423Medicaid