Provider Demographics
NPI:1174932073
Name:CLEMENTE, KATHERINE (FNP-BC, MSN, RN, BSN)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:CLEMENTE
Suffix:
Gender:F
Credentials:FNP-BC, MSN, RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 N BEERS ST
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1524
Mailing Address - Country:US
Mailing Address - Phone:732-203-9680
Mailing Address - Fax:
Practice Address - Street 1:717 N BEERS ST
Practice Address - Street 2:SUITE 2D
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1524
Practice Address - Country:US
Practice Address - Phone:732-203-9680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00511200363LF0000X
NYF338992-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily