Provider Demographics
NPI:1154857621
Name:FLEMING, NICOLE LOUISE
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LOUISE
Last Name:FLEMING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 S 4TH ST STE 119
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4792
Mailing Address - Country:US
Mailing Address - Phone:701-795-3896
Mailing Address - Fax:701-795-3838
Practice Address - Street 1:311 S 4TH ST STE 119
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4792
Practice Address - Country:US
Practice Address - Phone:701-795-3896
Practice Address - Fax:701-795-3838
Is Sole Proprietor?:No
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator