Provider Demographics
NPI:1396985560
Name:FLETCHER, ANNETTE ANNMARIE
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:ANNMARIE
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13703 RYBAK AVE
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-5238
Mailing Address - Country:US
Mailing Address - Phone:216-410-2766
Mailing Address - Fax:
Practice Address - Street 1:13703 RYBAK AVE
Practice Address - Street 2:
Practice Address - City:GARFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44125-5238
Practice Address - Country:US
Practice Address - Phone:216-410-2766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
OH400553321106376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2894819Medicaid