Provider Demographics
NPI:1902993942
Name:CLEMEN, JANE ANN (RD/LD)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:ANN
Last Name:CLEMEN
Suffix:
Gender:F
Credentials:RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22750 WULFEKUHLE RD
Mailing Address - Street 2:
Mailing Address - City:HOLY CROSS
Mailing Address - State:IA
Mailing Address - Zip Code:52053-9719
Mailing Address - Country:US
Mailing Address - Phone:563-245-7000
Mailing Address - Fax:563-245-7080
Practice Address - Street 1:901 DAVIDSON ST NW
Practice Address - Street 2:
Practice Address - City:ELKADER
Practice Address - State:IA
Practice Address - Zip Code:52043-9015
Practice Address - Country:US
Practice Address - Phone:563-245-7000
Practice Address - Fax:563-245-7080
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA305 00097133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI10547Medicare ID - Type Unspecified