Provider Demographics
NPI:1922280353
Name:MIRONDA CLEMENTS
Entity Type:Organization
Organization Name:MIRONDA CLEMENTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PRACTICAL NURSE
Authorized Official - Prefix:
Authorized Official - First Name:MIRONDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLEMENTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-780-6795
Mailing Address - Street 1:22709 LAKE SHORE BLVD
Mailing Address - Street 2:246C
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-1359
Mailing Address - Country:US
Mailing Address - Phone:216-780-6795
Mailing Address - Fax:
Practice Address - Street 1:22709 LAKE SHORE BLVD
Practice Address - Street 2:246C
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-1359
Practice Address - Country:US
Practice Address - Phone:216-780-6795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2007-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-126116 IV251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care