Provider Demographics
NPI:1407485287
Name:KLEMENTSON, ANGELA S (ARNP)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:S
Last Name:KLEMENTSON
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 1:606 OAKESDALE AVE SW STE C200
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-5227
Mailing Address - Country:US
Mailing Address - Phone:866-259-1629
Mailing Address - Fax:
Practice Address - Street 1:606 OAKESDALE AVE SW STE 200
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5227
Practice Address - Country:US
Practice Address - Phone:206-508-0197
Practice Address - Fax:855-666-8541
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60992288363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily