Provider Demographics
NPI:1154733830
Name:CLEMONS, DEMETRIA S (RN)
Entity type:Individual
Prefix:MRS
First Name:DEMETRIA
Middle Name:S
Last Name:CLEMONS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:DEMETRIA
Other - Middle Name:S
Other - Last Name:FULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:144 BUSINESS PARK DR STE 202
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6527
Mailing Address - Country:US
Mailing Address - Phone:757-937-9569
Mailing Address - Fax:757-937-9570
Practice Address - Street 1:144 BUSINESS PARK DR STE 202
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6527
Practice Address - Country:US
Practice Address - Phone:757-937-9569
Practice Address - Fax:757-937-9570
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2023-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-251653163WH0200X, 164W00000X, 251E00000X, 251J00000X, 3747P1801X, 385H00000X
VA0001211714163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No385H00000XRespite Care FacilityRespite Care