Provider Demographics
NPI:1548683857
Name:CLEMENTS, ENKELEJDA
Entity type:Individual
Prefix:MRS
First Name:ENKELEJDA
Middle Name:
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ENKELEJDA
Other - Middle Name:
Other - Last Name:PALLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:8760 ROSEBUD PL
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-9294
Mailing Address - Country:US
Mailing Address - Phone:303-564-1578
Mailing Address - Fax:
Practice Address - Street 1:8760 ROSEBUD PLACE
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134
Practice Address - Country:US
Practice Address - Phone:303-564-1578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0197376163WG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0100XNursing Service ProvidersRegistered NurseGastroenterology