Provider Demographics
NPI:1487227500
Name:CLEMENTS, CAMILLE NOELLE (APRN, CNM)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:NOELLE
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:APRN, CNM
Other - Prefix:
Other - First Name:CAMILLE
Other - Middle Name:NOELLE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2400 E 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5206
Mailing Address - Country:US
Mailing Address - Phone:907-561-2626
Mailing Address - Fax:
Practice Address - Street 1:2400 E 42ND AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5206
Practice Address - Country:US
Practice Address - Phone:907-561-2626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK178402367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty