Healthcare Provider Details

I. General information

NPI: 1356088850
Provider Name (Legal Business Name): DIANE BELTON-FLEMMING CNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 05/16/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22101 MOROSS RD BLDG 135
DETROIT MI
48236-2148
US

IV. Provider business mailing address

16760 VAUGHAN ST
DETROIT MI
48219-3356
US

V. Phone/Fax

Practice location:
  • Phone: 313-414-8875
  • Fax:
Mailing address:
  • Phone: 313-414-8875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number4704214959
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: