Provider Demographics
NPI:1386088664
Name:CLEMENTS, CARYN SUE (RN)
Entity type:Individual
Prefix:
First Name:CARYN
Middle Name:SUE
Last Name:CLEMENTS
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 1:23001 SHELTERING SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-5440
Mailing Address - Country:US
Mailing Address - Phone:907-688-2335
Mailing Address - Fax:
Practice Address - Street 1:23001 SHELTERING SPRUCE AVE
Practice Address - Street 2:
Practice Address - City:CHUGIAK
Practice Address - State:AK
Practice Address - Zip Code:99567-5440
Practice Address - Country:US
Practice Address - Phone:907-688-2335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704234531163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care