Provider Demographics
NPI:1992944847
Name:FLETCHER, MARIECHANTAL (DNP FNP-BC)
Entity type:Individual
Prefix:DR
First Name:MARIECHANTAL
Middle Name:
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:DNP FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 FORBES BLVD STE 430
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-6301
Mailing Address - Country:US
Mailing Address - Phone:301-321-7741
Mailing Address - Fax:
Practice Address - Street 1:14300 GALLANT FOX LN STE 202
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-4033
Practice Address - Country:US
Practice Address - Phone:301-321-7741
Practice Address - Fax:301-291-7071
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNP1031572363LP0808X, 363LF0000X
MDR209991363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD854305400Medicaid
DC010287032Medicaid