| Doctor Name: | BERTHA ANN CLEM |
| NPI Number: | 1164736732 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | RN128530 |
| Business Practice Address: | Highway 191 & Hospital Road Chinle, AZ - 86503 |
| Business Phone Number: | 9286747166 |
| Business Fax Number: | 9286747705 |
| Mailing Address: | Po Box Ph, CHINLE |
| State: | AZ |
| Postal Code: | 865038000 |
| Phone Number: | 9286747166 |
| Fax Number: | 9286747705 |
| NPI Enumeration Date: | 08/05/2010 |
| NPI Last Update Date: | 12/30/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP0200X |
| License Number: | RN128530 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |