Provider Demographics
NPI:1639838980
Name:KLEMKOW, DONALD
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:KLEMKOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 4TH ST SE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-5868
Mailing Address - Country:US
Mailing Address - Phone:253-334-7264
Mailing Address - Fax:
Practice Address - Street 1:1518 4TH ST SE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-5868
Practice Address - Country:US
Practice Address - Phone:253-334-7264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider