Provider Demographics
NPI:1205277654
Name:CLERICI, DOROTHY RENEE (FNP)
Entity type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:RENEE
Last Name:CLERICI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 WALTS RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47122-9423
Mailing Address - Country:US
Mailing Address - Phone:812-951-0387
Mailing Address - Fax:
Practice Address - Street 1:140 WHITTINGTON PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4930
Practice Address - Country:US
Practice Address - Phone:502-327-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28154312A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner