Provider Demographics
NPI:1992049209
Name:FLETCHER, RENEE ANTONETTE (CRNP FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:ANTONETTE
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:CRNP FNP-BC
Other - Prefix:MRS
Other - First Name:RENEE
Other - Middle Name:ANTONETTE
Other - Last Name:FLETCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP FNP-BC
Mailing Address - Street 1:1401 PULASKI HWY STE W
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21040-1398
Mailing Address - Country:US
Mailing Address - Phone:104-671-6900
Mailing Address - Fax:410-671-6901
Practice Address - Street 1:1401 PULASKI HWY STE W
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:MD
Practice Address - Zip Code:21040-1398
Practice Address - Country:US
Practice Address - Phone:410-671-6900
Practice Address - Fax:410-671-6901
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR199709363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1840347P0001Medicaid