Healthcare Provider Details

I. General information

NPI: 1346896594
Provider Name (Legal Business Name): MARY E. CLEMENTI FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY E. GOODALE APRN

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 W. LAYTON AVE
GREENFIELD WI
53220
US

IV. Provider business mailing address

5800 W. LAYTON AVE
GREENFIELD WI
53220
US

V. Phone/Fax

Practice location:
  • Phone: 262-532-3067
  • Fax:
Mailing address:
  • Phone: 262-532-3067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF04190076
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: