Basic Information
| Provider Information | |||||||||
| NPI: | 1275800070 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLEMENT | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 28 GLENVIEW DR | ||||||||
| Address2: | |||||||||
| City: | KENSINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060371142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608292002 | ||||||||
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| Practice Location | |||||||||
| Address1: | 263 FARMINGTON AVE | ||||||||
| Address2: | OCCUPATIONAL MEDICINE | ||||||||
| City: | FARMINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060306210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606792893 | ||||||||
| FaxNumber: | 8606794587 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2011 | ||||||||
| LastUpdateDate: | 09/20/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 004831 | CT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1275800070 | 05 | CT | MEDICAID |