Provider Demographics
NPI:1922601582
Name:CLARKSTON, NATALIE SUE
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:SUE
Last Name:CLARKSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3360 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:AMELIA
Mailing Address - State:OH
Mailing Address - Zip Code:45102-2033
Mailing Address - Country:US
Mailing Address - Phone:513-344-5756
Mailing Address - Fax:
Practice Address - Street 1:3360 SMITH RD
Practice Address - Street 2:
Practice Address - City:AMELIA
Practice Address - State:OH
Practice Address - Zip Code:45102-2033
Practice Address - Country:US
Practice Address - Phone:513-344-5756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide