Provider Demographics
NPI:1568903623
Name:FLEMING, MARY COLEEN (M AC, L AC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:COLEEN
Last Name:FLEMING
Suffix:
Gender:F
Credentials:M AC, L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2373 G RD STE 220
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1006
Mailing Address - Country:US
Mailing Address - Phone:970-243-3456
Mailing Address - Fax:970-243-0383
Practice Address - Street 1:2373 G RD STE 220
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1006
Practice Address - Country:US
Practice Address - Phone:970-243-3456
Practice Address - Fax:970-243-0383
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1678171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist