Provider Demographics
NPI:1699579359
Name:CLEMENTS, NATASHA SHARESE (RN)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:SHARESE
Last Name:CLEMENTS
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:S
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5947 HILLARY
Mailing Address - Street 2:
Mailing Address - City:TROTWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45426-1482
Mailing Address - Country:US
Mailing Address - Phone:937-838-0372
Mailing Address - Fax:
Practice Address - Street 1:5947 HILLARY
Practice Address - Street 2:
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45426-1482
Practice Address - Country:US
Practice Address - Phone:937-838-0372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH409165163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse