Provider Demographics
NPI:1174276638
Name:CLEMONS, DONNA
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:CLEMONS
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 1:1371 NORWOOD HILLS DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-5561
Mailing Address - Country:US
Mailing Address - Phone:636-259-0899
Mailing Address - Fax:
Practice Address - Street 1:1371 NORWOOD HILLS DR
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-5561
Practice Address - Country:US
Practice Address - Phone:636-259-0899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide