Provider Demographics
NPI:1225249758
Name:FLEMING IVES, JENIFER MARY (CNM MSN)
Entity Type:Individual
Prefix:MS
First Name:JENIFER
Middle Name:MARY
Last Name:FLEMING IVES
Suffix:
Gender:F
Credentials:CNM MSN
Other - Prefix:MS
Other - First Name:JENIFER
Other - Middle Name:MARY
Other - Last Name:FLEMING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNM MSN
Mailing Address - Street 1:15 DRYADS GREEN
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060
Mailing Address - Country:US
Mailing Address - Phone:413-586-4006
Mailing Address - Fax:
Practice Address - Street 1:16 CENTER ST
Practice Address - Street 2:TAPESTRY HEALTH SUITE 415
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060
Practice Address - Country:US
Practice Address - Phone:413-586-2539
Practice Address - Fax:413-586-1371
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA192184367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CND248OtherBCBS
CT192184OtherCONNECTICARE
CT192184OtherCONNECTICARE