Provider Demographics
NPI:1750086583
Name:FLETCHER, RENEE R (MSN, RN, CNS)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:R
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:MSN, RN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 LOW OAK ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1814
Mailing Address - Country:US
Mailing Address - Phone:210-687-6284
Mailing Address - Fax:
Practice Address - Street 1:4125 MCCULLOUGH AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-1903
Practice Address - Country:US
Practice Address - Phone:210-615-1366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP107442364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical