MEDICARE: MELISSA CLEMENS NP

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	363LF0000X	Family Nurse Practitioner	337992	NY

General Provider Information

NPI Number	:	1699111013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA CLEMENS NP

Provider Business Mailing Address
First Line	:	1211 COUNTY ROUTE 84
Second Line	:
City	:	HASTINGS
State	:	NY
Zip	:	13076-4134
Country	:	US
Telephone Number	:	315-491-2029
Fax Number	:

Provider Business Practice Location Address
First Line	:	1211 COUNTY ROUTE 84
Second Line	:
City	:	HASTINGS
State	:	NY
Zip	:	13076-4134
Country	:	US
Telephone Number	:	315-491-2029
Fax Number	:

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

Provider Enumeration Date	:	05/13/2013
Last Update Date	:	10/09/2017

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