MEDICARE: DONNA JEANNE FEMINO CLARK APRN BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	120402	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PN0682	OTHER		BCBS

General Provider Information

NPI Number	:	1356431530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA JEANNE FEMINO CLARK APRN BC

Provider Business Mailing Address
First Line	:	POB 1495
Second Line	:	84 RYDER RD
City	:	NORTH FALMOUTH
State	:	MA
Zip	:	02556-1495
Country	:	US
Telephone Number	:	508-563-7220
Fax Number	:	508-563-7220

Provider Business Practice Location Address
First Line	:	84 RYDER RD
Second Line	:
City	:	NORTH FALMOUTH
State	:	MA
Zip	:	02556-1495
Country	:	US
Telephone Number	:	508-563-7220
Fax Number	:	508-563-7220

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	06/30/2008

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