Healthcare Provider Details

I. General information

NPI: 1699679951
Provider Name (Legal Business Name): LEAH CLEM BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 LAFAYETTE ST
WILMINGTON NC
28411-6792
US

IV. Provider business mailing address

188 LAFAYETTE ST
WILMINGTON NC
28411-6792
US

V. Phone/Fax

Practice location:
  • Phone: 910-319-8500
  • Fax:
Mailing address:
  • Phone: 910-319-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number381049
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: