1982675237 NPI number — MARY BETH FLETCHER CRNA

Table of content: MARY BETH FLETCHER CRNA (NPI 1982675237)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982675237 NPI number — MARY BETH FLETCHER CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLETCHER
Provider First Name:
MARY
Provider Middle Name:
BETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982675237
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 S FLOYD ST
Provider Second Line Business Mailing Address:
SUITE 407
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40202-1835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-629-2880
Provider Business Mailing Address Fax Number:
502-629-2879

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4001 DUTCHMANS LN
Provider Second Line Business Practice Location Address:
NORTON SUBURBAN HOSPITAL
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207-4714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-893-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  558514 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)