Provider Demographics
NPI:1679864912
Name:FLEMING, NATHAN (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:FLEMING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 SPRINGFIELD DR STE 175
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-5398
Mailing Address - Country:US
Mailing Address - Phone:530-781-1440
Mailing Address - Fax:530-342-1663
Practice Address - Street 1:1515 SPRINGFIELD DR STE 175
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-5398
Practice Address - Country:US
Practice Address - Phone:530-781-1440
Practice Address - Fax:530-342-1483
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC191507208000000X
WI62546-20208000000X
MN60207208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1679864912Medicaid