Provider Demographics
NPI:1114688041
Name:FLETCHER, THEODORE RAE (RN, PHN, ACRN)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:RAE
Last Name:FLETCHER
Suffix:
Gender:M
Credentials:RN, PHN, ACRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 NATIVIDAD RD
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906-3144
Mailing Address - Country:US
Mailing Address - Phone:831-417-9783
Mailing Address - Fax:
Practice Address - Street 1:1270 NATIVIDAD RD
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3144
Practice Address - Country:US
Practice Address - Phone:831-796-1236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-03
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN95248292163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management