Provider Demographics
NPI:1437325131
Name:FLEMING, MARY CAROL (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY CAROL
Middle Name:
Last Name:FLEMING
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX B
Mailing Address - Street 2:SAIC FREDERICK / NCI FREDERICK
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21754
Mailing Address - Country:US
Mailing Address - Phone:301-846-1096
Mailing Address - Fax:310-846-6150
Practice Address - Street 1:1050 BOYLES ST
Practice Address - Street 2:BLDG 426
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-9242
Practice Address - Country:US
Practice Address - Phone:301-846-1096
Practice Address - Fax:310-846-6150
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR048232363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health