MEDICARE: MADISON JOY CLEMENS APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WU0100X	Urology Registered Nurse	2477537	MN
2	363LF0000X	Family Nurse Practitioner	2477537	MN
3	363L00000X	Nurse Practitioner	11718	MN

General Provider Information

NPI Number	:	1285487751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON JOY CLEMENS APRN

Provider Business Mailing Address
First Line	:	8170 33RD AVE S # MS 21110Q
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55425-4516
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5400 EXCELSIOR BLVD
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55416-2913
Country	:	US
Telephone Number	:	320-291-3539
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2024
Last Update Date	:	07/18/2024

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