Provider Demographics
NPI:1356088850
Name:BELTON-FLEMMING, DIANE (CNS-BC)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:
Last Name:BELTON-FLEMMING
Suffix:
Gender:F
Credentials:CNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16760 VAUGHAN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-3356
Mailing Address - Country:US
Mailing Address - Phone:313-414-8875
Mailing Address - Fax:
Practice Address - Street 1:22101 MOROSS RD BLDG 135
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2148
Practice Address - Country:US
Practice Address - Phone:313-414-8875
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704214959364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist