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General NPI Number Information
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NPI Number | 1003829805
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Entity Type | Individual
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Provider Name | CARLA PATRICE CLEMENTS RN, CRNP
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Gender | Female
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 3900 WOODLAND AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4551
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Country | US
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Telephone | 215-823-5800
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Fax |
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Provider Business Mailing Address
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Address Line | 714 QUEST CT
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City | MANTUA
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State | NJ
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Zip | 08051-2282
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Country | US
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Telephone | 856-468-7278
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN342711L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | RN342711L
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License Number State | PA
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