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General NPI Number Information
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NPI Number | 1457911281
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Entity Type | Individual
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Provider Name | MEGAN CLEMENCE NP-C
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Gender | Female
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Dates
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Enumeration Date | 06/14/2019
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Last Update Date | 07/29/2019
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Provider Practice Location Address
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Address Line | 7210 N MAIN ST STE 200
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City | CLARKSTON
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State | MI
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Zip | 48346-1575
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Country | US
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Telephone | 248-625-1600
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Fax |
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Provider Business Mailing Address
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Address Line | 7188 N MAIN ST
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City | CLARKSTON
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State | MI
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Zip | 48346-1571
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Country | US
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Telephone | 248-770-8767
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704313477
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License Number State | MI
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