Basic Information
| Provider Information | |||||||||
| NPI: | 1083914766 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLEMENCE | ||||||||
| FirstName: | DEVIN | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 JOHN ST STE 401 | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2694888336 | ||||||||
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| Practice Location | |||||||||
| Address1: | 601 S US 131 | ||||||||
| Address2: | |||||||||
| City: | THREE RIVERS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2692867070 | ||||||||
| FaxNumber: | 2692867071 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2010 | ||||||||
| LastUpdateDate: | 10/02/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 096-002993 | IL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer | 363A00000X | 5601007457 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.