Provider Demographics
NPI:1104112218
Name:CLEMENT, CHERRY WINNIFRED (RN)
Entity type:Individual
Prefix:MS
First Name:CHERRY
Middle Name:WINNIFRED
Last Name:CLEMENT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22596 STRATFORD CT
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-6861
Mailing Address - Country:US
Mailing Address - Phone:951-210-5660
Mailing Address - Fax:951-992-1551
Practice Address - Street 1:22596 STRATFORD CT
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-6861
Practice Address - Country:US
Practice Address - Phone:951-210-5660
Practice Address - Fax:951-992-1551
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA520145163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse