Provider Demographics
NPI:1629954615
Name:CLARK-BASS, DEANNA DEMETRIA
Entity type:Individual
Prefix:MRS
First Name:DEANNA
Middle Name:DEMETRIA
Last Name:CLARK-BASS
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 1:610 PEARL KNOLL CIR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-2600
Mailing Address - Country:US
Mailing Address - Phone:919-884-8545
Mailing Address - Fax:
Practice Address - Street 1:437 DIMMOCKS MILL RD STE 23
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-2379
Practice Address - Country:US
Practice Address - Phone:984-327-8190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care