Provider Demographics
NPI:1528210135
Name:FLEISHMAN, JUDITH (FNP)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:FLEISHMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 LAKE LANSING RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3618
Mailing Address - Country:US
Mailing Address - Phone:517-371-4712
Mailing Address - Fax:517-371-3116
Practice Address - Street 1:2414 LAKE LANSING RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3618
Practice Address - Country:US
Practice Address - Phone:517-371-4712
Practice Address - Fax:517-371-3116
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704174388363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily