Provider Demographics
NPI:1700308400
Name:CLEMENS, MARY CHRISTINE (RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CHRISTINE
Last Name:CLEMENS
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 1:2060 CENTER POINT BLVD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:ST. PAU
Mailing Address - State:MN
Mailing Address - Zip Code:55120-1306
Mailing Address - Country:US
Mailing Address - Phone:651-774-0011
Mailing Address - Fax:
Practice Address - Street 1:2060 CENTRE POINTE BLVD STE 3
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55120-1271
Practice Address - Country:US
Practice Address - Phone:651-774-0011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR132683-5163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse