Provider Demographics
NPI:1407015647
Name:FLETCHER, GWENDOLYN ELLEN (MD)
Entity Type:Individual
Prefix:MRS
First Name:GWENDOLYN
Middle Name:ELLEN
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:GWENDOLYN
Other - Middle Name:ELLEN
Other - Last Name:FLOWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3087 TIMBER BROOK DR
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-3536
Mailing Address - Country:US
Mailing Address - Phone:419-367-4287
Mailing Address - Fax:
Practice Address - Street 1:3087 TIMBER BROOK DR
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-3536
Practice Address - Country:US
Practice Address - Phone:419-367-4287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57013400207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine