Provider Demographics
NPI:1124036348
Name:CLEMENS, GLENDA JEAN (ARNP)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:JEAN
Last Name:CLEMENS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 4TH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1607
Mailing Address - Country:US
Mailing Address - Phone:206-838-6856
Mailing Address - Fax:206-838-3085
Practice Address - Street 1:1525 4TH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1607
Practice Address - Country:US
Practice Address - Phone:206-838-6856
Practice Address - Fax:206-838-3085
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0069330363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200031570AMedicaid
OK247606601Medicare PIN
OKOK700556Medicare PIN