Provider Demographics
NPI:1871142992
Name:CLEMENT, VIRGIE LEE
Entity type:Individual
Prefix:MRS
First Name:VIRGIE
Middle Name:LEE
Last Name:CLEMENT
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 1:9704 KENDAL DR
Mailing Address - Street 2:9704 KENDAL DR
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753
Mailing Address - Country:US
Mailing Address - Phone:401-649-6616
Mailing Address - Fax:
Practice Address - Street 1:9704 KENDAL DR
Practice Address - Street 2:9704 KENDAL DR
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753
Practice Address - Country:US
Practice Address - Phone:401-649-6616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider