Healthcare Provider Details

I. General information

NPI: 1609206432
Provider Name (Legal Business Name): EMILY KAYE CLEMENTSON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY KAYE LUFHOLM RN

II. Dates (important events)

Enumeration Date: 11/14/2013
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 NE MOTHER JOSEPH PL
VANCOUVER WA
98664-3200
US

IV. Provider business mailing address

505 NE 87TH AVE STE 210
VANCOUVER WA
98664-1988
US

V. Phone/Fax

Practice location:
  • Phone: 360-828-5396
  • Fax: 360-828-5455
Mailing address:
  • Phone: 360-828-5396
  • Fax: 360-828-5455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number679753
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number61648889
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: