Provider Demographics
NPI:1558514463
Name:CLEMENTS, RODNEY JOHN (LPN)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:JOHN
Last Name:CLEMENTS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 NORTH ST
Mailing Address - Street 2:PO BOX 350
Mailing Address - City:LIVONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14487-9736
Mailing Address - Country:US
Mailing Address - Phone:585-243-7290
Mailing Address - Fax:585-243-7287
Practice Address - Street 1:2 MURRAY HL
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:NY
Practice Address - Zip Code:14510-1122
Practice Address - Country:US
Practice Address - Phone:585-243-7290
Practice Address - Fax:585-243-7287
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY254973-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY254973-1OtherLPN LICENSE