Provider Demographics
NPI:1730352295
Name:CLEMONS, LAKISHA REFAY (RN)
Entity type:Individual
Prefix:MS
First Name:LAKISHA
Middle Name:REFAY
Last Name:CLEMONS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4037 N 84TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-1811
Mailing Address - Country:US
Mailing Address - Phone:414-461-0418
Mailing Address - Fax:
Practice Address - Street 1:4037 N 84TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-1811
Practice Address - Country:US
Practice Address - Phone:414-461-0418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-05
Last Update Date:2008-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38318700OtherPROVIDER NUMBER