Provider Demographics
NPI:1053044941
Name:CLEMENTE, JENIFER NATALIE
Entity Type:Individual
Prefix:MS
First Name:JENIFER
Middle Name:NATALIE
Last Name:CLEMENTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 LOCKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHIRELY
Mailing Address - State:NY
Mailing Address - Zip Code:11967
Mailing Address - Country:US
Mailing Address - Phone:631-806-4181
Mailing Address - Fax:
Practice Address - Street 1:485 LOCKWOOD DR
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-1117
Practice Address - Country:US
Practice Address - Phone:631-806-4181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY459617163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice