Provider Demographics
NPI:1245215490
Name:CLEMONS, MARGARET L (NP)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:L
Last Name:CLEMONS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 421
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0421
Mailing Address - Country:US
Mailing Address - Phone:509-474-6842
Mailing Address - Fax:509-227-7070
Practice Address - Street 1:104 W 5TH AVE
Practice Address - Street 2:SUITE 200W
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-4880
Practice Address - Country:US
Practice Address - Phone:509-744-3750
Practice Address - Fax:509-744-3969
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP0004159363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9640160Medicaid
P00211634OtherRAILROAD MCR
WA9640160Medicaid
P00211634OtherRAILROAD MCR