Provider Demographics
NPI:1609555622
Name:CLEMENT, BRONWEN LANCLOS (MSN, APRN-CNM)
Entity Type:Individual
Prefix:MRS
First Name:BRONWEN
Middle Name:LANCLOS
Last Name:CLEMENT
Suffix:
Gender:F
Credentials:MSN, APRN-CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 COOLIDGE ST STE B
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2309
Mailing Address - Country:US
Mailing Address - Phone:337-412-4373
Mailing Address - Fax:
Practice Address - Street 1:715 COOLIDGE ST STE B
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2309
Practice Address - Country:US
Practice Address - Phone:337-412-4373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA230570367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife