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General NPI Number Information
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NPI Number | 1275886640
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Entity Type | Individual
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Provider Name | RONDALIE KING-CLARKE CNA
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Gender | Female
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Dates
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Enumeration Date | 10/22/2012
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Last Update Date | 10/22/2012
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Provider Practice Location Address
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Address Line | 1012 BAY 30TH ST
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-1842
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Country | US
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Telephone | 718-885-6572
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Fax |
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Provider Business Mailing Address
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Address Line | 1012 BAY 30TH ST
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-1842
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Country | US
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Telephone | 718-885-6572
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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 | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 342364201105E
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License Number State | NY
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