Provider Demographics
NPI:1629712690
Name:FLETCHER, ISAAC D JR
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:D
Last Name:FLETCHER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5267 GLENCRAG WAY
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-5202
Mailing Address - Country:US
Mailing Address - Phone:419-870-5849
Mailing Address - Fax:
Practice Address - Street 1:5267 GLENCRAG WAY
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-5202
Practice Address - Country:US
Practice Address - Phone:419-870-5849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide