Provider Demographics
NPI:1497152722
Name:CLEMENT, DONNA GAINES (RDN, LDN, MPH, CNSC)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:GAINES
Last Name:CLEMENT
Suffix:
Gender:F
Credentials:RDN, LDN, MPH, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2150 HERBERT CT
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3736
Practice Address - Country:US
Practice Address - Phone:252-744-4963
Practice Address - Fax:252-744-2791
Is Sole Proprietor?:No
Enumeration Date:2014-12-02
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL998474133V00000X
NCL003613133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered