Provider Demographics
NPI:1356623508
Name:CLARKE, JENNIFER J (RN)
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:J
Last Name:CLARKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 WASHINGTON ST
Mailing Address - Street 2:APARTMENT 3-O
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-3118
Mailing Address - Country:US
Mailing Address - Phone:516-214-6631
Mailing Address - Fax:
Practice Address - Street 1:150 WASHINGTON ST
Practice Address - Street 2:APARTMENT 3-O
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-3118
Practice Address - Country:US
Practice Address - Phone:516-214-6631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY649005163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse