Provider Demographics
NPI:1851276695
Name:CLEMENTS-BAZER, BRIANA RENE
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:RENE
Last Name:CLEMENTS-BAZER
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 1:3538 11TH AVE N APT 17
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58203-2157
Mailing Address - Country:US
Mailing Address - Phone:701-330-2647
Mailing Address - Fax:
Practice Address - Street 1:3783 S 16TH ST APT 118
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-5332
Practice Address - Country:US
Practice Address - Phone:701-521-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide