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General NPI Number Information
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NPI Number | 1124434501
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Entity Type | Organization
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Legal Business Name | JAN CLEMENTS AGNP CORP
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Dates
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Enumeration Date | 07/07/2014
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Last Update Date | 07/07/2014
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Provider Practice Location Address
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Address Line | 66 E STATE RD
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-2637
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Country | US
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Telephone | 801-796-7961
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Fax | 801-796-1101
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Provider Business Mailing Address
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Address Line | 66 E STATE RD
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-2637
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Country | US
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Telephone | 801-796-7961
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Fax | 801-796-1101
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Authorized Official
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Title or Position | NURSE PRACTIONER
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Name | MS. JAN CLEMENTS
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Credential | N.P.
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Telephone | 801-796-7961
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 1938944405
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License Number State | UT
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