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General NPI Number Information
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NPI Number | 1285487751
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Entity Type | Individual
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Provider Name | MADISON JOY CLEMENS APRN
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Gender | Female
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Dates
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Enumeration Date | 04/08/2024
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Last Update Date | 07/18/2024
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Provider Practice Location Address
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Address Line | 5400 EXCELSIOR BLVD
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City | MINNEAPOLIS
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State | MN
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Zip | 55416-2913
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Country | US
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Telephone | 320-291-3539
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Fax |
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Provider Business Mailing Address
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Address Line | 8170 33RD AVE S # MS 21110Q
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City | BLOOMINGTON
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State | MN
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Zip | 55425-4516
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Country | US
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Telephone |
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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 | 163WU0100X
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Taxonomy Name | Urology Registered Nurse
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License Number | 2477537
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2477537
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11718
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License Number State | MN
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