Provider Demographics
NPI:1194272773
Name:FLETCHER, REBECCAH L (DNP, APN, CNM)
Entity type:Individual
Prefix:
First Name:REBECCAH
Middle Name:L
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:DNP, APN, CNM
Other - Prefix:
Other - First Name:REBECCAH
Other - Middle Name:L
Other - Last Name:HARPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:715 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-4209
Mailing Address - Country:US
Mailing Address - Phone:970-249-6737
Mailing Address - Fax:970-252-0112
Practice Address - Street 1:715 S 3RD ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4209
Practice Address - Country:US
Practice Address - Phone:970-249-6737
Practice Address - Fax:970-252-0112
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0996216-CNM367A00000X
IL209.014975367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL370966854017Medicaid
IL640701Medicare PIN