Provider Demographics
NPI:1831736222
Name:CHURCH, EARNEST CLAYTON (RN, CDE)
Entity type:Individual
Prefix:MR
First Name:EARNEST
Middle Name:CLAYTON
Last Name:CHURCH
Suffix:
Gender:M
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 HAMPDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19604-1827
Mailing Address - Country:US
Mailing Address - Phone:610-375-4532
Mailing Address - Fax:
Practice Address - Street 1:1409 HAMPDEN BLVD
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19604-1827
Practice Address - Country:US
Practice Address - Phone:610-375-4532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN348935L163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Single Specialty