Provider Demographics
NPI:1023775079
Name:MCLEMORE, GIVONDA MARIE
Entity type:Individual
Prefix:
First Name:GIVONDA
Middle Name:MARIE
Last Name:MCLEMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7123A W GREENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53214-4709
Mailing Address - Country:US
Mailing Address - Phone:414-301-0255
Mailing Address - Fax:
Practice Address - Street 1:7123A W GREENFIELD AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53214-4709
Practice Address - Country:US
Practice Address - Phone:414-301-0255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-24
Last Update Date:2021-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide