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General NPI Number Information
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NPI Number | 1174592406
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Entity Type | Individual
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Provider Name | MRS. BRENDA L CLARKE
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Gender | Female
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Dates
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Enumeration Date | 03/17/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 25 W MAIN ST
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City | WEST CARROLLTON
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State | OH
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Zip | 45449-1419
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Country | US
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Telephone | 937-866-0809
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Fax |
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Provider Business Mailing Address
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Address Line | 2311 ALPINE WAY
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City | DAYTON
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State | OH
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Zip | 45406-2102
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Country | US
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Telephone | 937-278-4574
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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