Provider Demographics
NPI:1568859973
Name:CLEMENS, ANDREA SUE (LPN)
Entity type:Individual
Prefix:MISS
First Name:ANDREA
Middle Name:SUE
Last Name:CLEMENS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 COUNTY ROAD X
Mailing Address - Street 2:
Mailing Address - City:KRONENWETTER
Mailing Address - State:WI
Mailing Address - Zip Code:54455-9282
Mailing Address - Country:US
Mailing Address - Phone:715-581-2053
Mailing Address - Fax:
Practice Address - Street 1:806 COUNTY ROAD X
Practice Address - Street 2:
Practice Address - City:KRONENWETTER
Practice Address - State:WI
Practice Address - Zip Code:54455-9282
Practice Address - Country:US
Practice Address - Phone:715-581-2053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI319041164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse