Provider Demographics
NPI:1346612066
Name:FIECHTER, LAURIE ANN
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:ANN
Last Name:FIECHTER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LAURIE
Other - Middle Name:ANN
Other - Last Name:KENGLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA
Mailing Address - Street 1:607 SW 24TH ST
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-7729
Mailing Address - Country:US
Mailing Address - Phone:239-410-4360
Mailing Address - Fax:
Practice Address - Street 1:991 PONDELLA RD
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-3500
Practice Address - Country:US
Practice Address - Phone:239-995-8809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA14356174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator