Provider Demographics
NPI:1326848037
Name:FLETCHER, DEVINA (MSN-FNP-BC)
Entity type:Individual
Prefix:
First Name:DEVINA
Middle Name:
Last Name:FLETCHER
Suffix:
Gender:
Credentials:MSN-FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 S DREXEL BLVD UNIT 302
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60653-3328
Mailing Address - Country:US
Mailing Address - Phone:312-965-3502
Mailing Address - Fax:
Practice Address - Street 1:5700 S MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1426
Practice Address - Country:US
Practice Address - Phone:312-965-3502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.029584363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily