Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0401X | Internist - Addiction Medicine | 10000891A | IN |
NPI | 1962562801 |
---|---|
Provider Name | Ms. Jennifer C Clemente-Metz |
First Address | Charlestown, IN 47111-9535 |
Second Address | Jeffersonville, IN 47130-6016 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 08/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10000891A | STATE LICENSE (01) | IN |
300006743 | (05) | IN |
IN3604007 | MEDICARE INDIANA (01) | IN |
PA745 | STATE LICENSE (01) | KY |