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General NPI Number Information
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NPI Number | 1629954615
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Entity Type | Individual
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Provider Name | MRS. DEANNA DEMETRIA CLARK-BASS
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Gender | Female
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Dates
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Enumeration Date | 08/14/2025
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 437 DIMMOCKS MILL RD STE 23
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City | HILLSBOROUGH
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State | NC
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Zip | 27278-2379
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Country | US
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Telephone | 984-327-8190
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Fax |
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Provider Business Mailing Address
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Address Line | 610 PEARL KNOLL CIR
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City | DURHAM
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State | NC
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Zip | 27703-2600
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Country | US
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Telephone | 919-884-8545
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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 | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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