MEDICARE: DARLENE CLENDANIEL APN,PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	26NJ15256600	NJ

General Provider Information

NPI Number	:	1427869635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARLENE CLENDANIEL APN,PMHNP

Provider Business Mailing Address
First Line	:	14 N PEARL ST
Second Line	:
City	:	BRIDGETON
State	:	NJ
Zip	:	08302-1902
Country	:	US
Telephone Number	:	856-340-9830
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 N PEARL ST
Second Line	:
City	:	BRIDGETON
State	:	NJ
Zip	:	08302-1902
Country	:	US
Telephone Number	:	856-340-9830
Fax Number	:

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

Provider Enumeration Date	:	01/16/2025
Last Update Date	:	01/16/2025

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