Provider Demographics
NPI:1134643646
Name:CLEMENT, AMY ELISABETH (PA-C)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:ELISABETH
Last Name:CLEMENT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:280 SIERRA COLLEGE DR STE 205
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5763
Mailing Address - Country:US
Mailing Address - Phone:530-273-8452
Mailing Address - Fax:
Practice Address - Street 1:280 SIERRA COLLEGE DR STE 205
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5763
Practice Address - Country:US
Practice Address - Phone:530-278-4523
Practice Address - Fax:530-477-5182
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL085006966363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant