Provider Demographics
NPI:1346675436
Name:CLEMENS, AUBREY ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:AUBREY
Middle Name:ANN
Last Name:CLEMENS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AUBREY
Other - Middle Name:ANN
Other - Last Name:PETERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33 HARRY AGGANIS WAY
Mailing Address - Street 2:BOX 9749
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-1307
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:33 HARRY AGGANIS WAY
Practice Address - Street 2:BOX 9749
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-1307
Practice Address - Country:US
Practice Address - Phone:801-721-4130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-07
Last Update Date:2013-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA4820363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant