Provider Demographics
NPI:1700423159
Name:CLEINMARK, KENDRA LYNNE (RN)
Entity Type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:LYNNE
Last Name:CLEINMARK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:LYNNE
Other - Last Name:HURT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3150 S AVENUE A
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7928
Mailing Address - Country:US
Mailing Address - Phone:928-502-6800
Mailing Address - Fax:
Practice Address - Street 1:3150 S AVENUE A
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-7928
Practice Address - Country:US
Practice Address - Phone:928-502-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-04
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ223474163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool