Provider Demographics
NPI:1811329352
Name:CLEMENTS, JULIA DAWN (LPN)
Entity type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:DAWN
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MARYLAND ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6450
Mailing Address - Country:US
Mailing Address - Phone:802-999-9423
Mailing Address - Fax:
Practice Address - Street 1:28 WHIPPLE ROAD
Practice Address - Street 2:BLANCHARD RESIDENCE
Practice Address - City:SOUTH HERO
Practice Address - State:VT
Practice Address - Zip Code:05486
Practice Address - Country:US
Practice Address - Phone:802-372-4020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT025.0088238164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse