Provider Demographics
NPI:1295563013
Name:CLEMENS, MELISSA M (MPA)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:M
Last Name:CLEMENS
Suffix:
Gender:F
Credentials:MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1093 LEONARD BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-3384
Mailing Address - Country:US
Mailing Address - Phone:330-697-1725
Mailing Address - Fax:
Practice Address - Street 1:1093 LEONARD BOULEVARD
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-3384
Practice Address - Country:US
Practice Address - Phone:330-697-1725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker