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General NPI Number Information
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NPI Number | 1205277654
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Entity Type | Individual
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Provider Name | DOROTHY RENEE CLERICI FNP
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Gender | Female
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Dates
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Enumeration Date | 07/15/2013
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Last Update Date | 07/15/2013
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Provider Practice Location Address
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Address Line | 140 WHITTINGTON PKWY SUITE 100
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City | LOUISVILLE
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State | KY
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Zip | 40222-4930
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Country | US
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Telephone | 502-327-9100
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Fax |
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Provider Business Mailing Address
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Address Line | 1075 WALTS RD
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City | GEORGETOWN
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State | IN
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Zip | 47122-9423
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Country | US
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Telephone | 812-951-0387
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 28154312A
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License Number State | IN
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