Basic Information
| Provider Information | |||||||||
| NPI: | 1881670024 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLEMING | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 LAPEER | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486071208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897596464 | ||||||||
| FaxNumber: | 9893998233 | ||||||||
| Practice Location | |||||||||
| Address1: | 3175 W. PROFESSIONAL DRIVE | ||||||||
| Address2: | |||||||||
| City: | BAY CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 487062823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9896673377 | ||||||||
| FaxNumber: | 9896679991 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2005 | ||||||||
| LastUpdateDate: | 03/08/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 4704117608 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 162771 | 01 | MN | GREAT LAKES HEALTH PLAN | OTHER | 50875 | 01 | MI | HEALTH PLAN OF MICHIGAN | OTHER | 1881670024 | 05 | MI | MEDICAID | 0998654 | 01 | MI | HEALTH PLUS OF MICHIGAN | OTHER | 1881670024 | 01 | MI | MOLINA HEALTHCARE OF MICHIGAN | OTHER | 381908328-382 | 01 | MI | CARE SOURCE OF MICHIGAN | OTHER | 420G310800 | 01 | MI | BLUE CROSS BLUE SHIELD OF MICHIGAN | OTHER |