Provider Demographics
NPI:1477077386
Name:CLEMMENS, COURTNEY LAUREN (CPNP-PC)
Entity Type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:LAUREN
Last Name:CLEMMENS
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 INTERNATIONAL CIR
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-1334
Mailing Address - Country:US
Mailing Address - Phone:410-433-2200
Mailing Address - Fax:410-785-1987
Practice Address - Street 1:301 INTERNATIONAL CIR STE 100
Practice Address - Street 2:
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21030-1334
Practice Address - Country:US
Practice Address - Phone:410-433-2200
Practice Address - Fax:410-785-1987
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-01
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR197530363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics