Provider Demographics
NPI:1396434114
Name:FLETCHER, LAURA DIANE (BC-FNP, C-ENP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:DIANE
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:BC-FNP, C-ENP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 OAK LEA DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-6755
Mailing Address - Country:US
Mailing Address - Phone:843-492-1306
Mailing Address - Fax:
Practice Address - Street 1:48 MEDICAL GROUP
Practice Address - Street 2:UNIT 5115
Practice Address - City:RAF LAKENHEATH
Practice Address - State:UK
Practice Address - Zip Code:09464
Practice Address - Country:GB
Practice Address - Phone:771-783-8460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC005455207Q00000X
SC107622163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine