Basic Information
| Provider Information | |||||||||
| NPI: | 1063886331 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLEMENTS | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | CNM, RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3630 | ||||||||
| Address2: | |||||||||
| City: | FLAGSTAFF | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 860033630 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2920 N 4TH ST | ||||||||
| Address2: | |||||||||
| City: | FLAGSTAFF | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 860041816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285229400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2015 | ||||||||
| LastUpdateDate: | 08/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | APN.0992882-CNM | CO | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 367A00000X | 4704315875 | MI | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 367A00000X | AP61093702 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 367A00000X | 261928 | AZ | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.