Provider Demographics
NPI:1760418131
Name:GERMANY, NANCY CLEARKIN (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:CLEARKIN
Last Name:GERMANY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4431
Mailing Address - Country:US
Mailing Address - Phone:318-675-1313
Mailing Address - Fax:318-675-1319
Practice Address - Street 1:1860 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4431
Practice Address - Country:US
Practice Address - Phone:318-675-1313
Practice Address - Fax:318-675-1319
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020120207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1388149Medicaid
LA5H114CK34Medicare PIN
LA5H114Medicare PIN
LA1388149Medicaid