Healthcare Provider Details

I. General information

NPI: 1629306949
Provider Name (Legal Business Name): CLARE MARY FLEMING LPN,CNHP,AANC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2009
Last Update Date: 11/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N COMMERCIAL ST STE D
SEYMOUR MO
65746-8859
US

IV. Provider business mailing address

2834 STATE HIGHWAY V P.O.BOX 279
SEYMOUR MO
65746-8047
US

V. Phone/Fax

Practice location:
  • Phone: 417-935-4470
  • Fax: 503-213-7404
Mailing address:
  • Phone: 417-935-4470
  • Fax: 503-213-7404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number75-3249909
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: