Doctor Name: | JOELLE TARA CLEMMER |
NPI Number: | 1376774505 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN |
License Number: | 00126735 |
Business Practice Address: | 550 Pope Ave Munson Army Health Clinic (attn: Mcxn-cod, Ms Cotton Fort Leavenworth, KS - 660272332 |
Business Phone Number: | 9136846208 |
Business Fax Number: | |
Mailing Address: | 206 Swift St, FORT LEAVENWORTH |
State: | KS |
Postal Code: | 660271112 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 08/05/2009 |
NPI Last Update Date: | 08/05/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163WC0400X |
License Number: | 00126735 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | Case Management |
Taxonomy Definition: |