Provider Demographics
NPI:1881670024
Name:FLEMING, MARY ANN (CNM)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:FLEMING
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:501 LAPEER
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48607-1208
Mailing Address - Country:US
Mailing Address - Phone:989-759-6464
Mailing Address - Fax:989-399-8233
Practice Address - Street 1:3175 W. PROFESSIONAL DRIVE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2823
Practice Address - Country:US
Practice Address - Phone:989-667-3377
Practice Address - Fax:989-667-9991
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704117608367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN162771OtherGREAT LAKES HEALTH PLAN
MI50875OtherHEALTH PLAN OF MICHIGAN
MI1881670024Medicaid
MI0998654OtherHEALTH PLUS OF MICHIGAN
MI1881670024OtherMOLINA HEALTHCARE OF MICHIGAN
MI381908328-382OtherCARE SOURCE OF MICHIGAN
MI420G310800OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MIS37145Medicare UPIN
MI0G36111-066Medicare PIN