Provider Demographics
NPI:1992243331
Name:MUNKSGARD, FLETCHER
Entity type:Individual
Prefix:
First Name:FLETCHER
Middle Name:
Last Name:MUNKSGARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:FLETCHER
Other - Middle Name:DANE
Other - Last Name:FRIEDMAN MUNKSGARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:154 FRISBIE ST APT 3
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5831
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21250 STEVENS CREEK BLVD
Practice Address - Street 2:STUDENT HEALTH SERVICES
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-5702
Practice Address - Country:US
Practice Address - Phone:408-864-8732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005899363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily