Provider Demographics
NPI:1356431530
Name:FEMINO CLARK, DONNA JEANNE (APRN BC)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:JEANNE
Last Name:FEMINO CLARK
Suffix:
Gender:F
Credentials:APRN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POB 1495
Mailing Address - Street 2:84 RYDER RD
Mailing Address - City:NORTH FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02556-1495
Mailing Address - Country:US
Mailing Address - Phone:508-563-7220
Mailing Address - Fax:508-563-7220
Practice Address - Street 1:84 RYDER RD
Practice Address - Street 2:
Practice Address - City:NORTH FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02556-1495
Practice Address - Country:US
Practice Address - Phone:508-563-7220
Practice Address - Fax:508-563-7220
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA120402364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
PN0682OtherBCBS