Provider Demographics
NPI:1528562097
Name:CLEMENTS, BENJAMIN (RN)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:CLEMENTS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1897 DOWNING AVE
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-4406
Mailing Address - Country:US
Mailing Address - Phone:612-201-6466
Mailing Address - Fax:
Practice Address - Street 1:1897 DOWNING AVE
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-4406
Practice Address - Country:US
Practice Address - Phone:612-201-6466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2458709163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health