Healthcare Provider Details

I. General information

NPI: 1881670024
Provider Name (Legal Business Name): MARY ANN FLEMING CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 03/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3175 W. PROFESSIONAL DRIVE
BAY CITY MI
48706-2823
US

IV. Provider business mailing address

501 LAPEER
SAGINAW MI
48607-1208
US

V. Phone/Fax

Practice location:
  • Phone: 989-667-3377
  • Fax: 989-667-9991
Mailing address:
  • Phone: 989-759-6464
  • Fax: 989-399-8233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number4704117608
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: