Provider Demographics
NPI:1285278861
Name:CLEMENSON, DEANNA ELIZABETH (RN)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:ELIZABETH
Last Name:CLEMENSON
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 1:38 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:SENECA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13148-2118
Mailing Address - Country:US
Mailing Address - Phone:315-568-5500
Mailing Address - Fax:
Practice Address - Street 1:38 GARDEN ST
Practice Address - Street 2:
Practice Address - City:SENECA FALLS
Practice Address - State:NY
Practice Address - Zip Code:13148-2118
Practice Address - Country:US
Practice Address - Phone:315-568-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY575608163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse