Provider Demographics
NPI:1659397248
Name:CLEMONS, PAMELA MARIE (BSN)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:MARIE
Last Name:CLEMONS
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 SIERRA VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MEADOW VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:95722-9578
Mailing Address - Country:US
Mailing Address - Phone:530-878-1834
Mailing Address - Fax:
Practice Address - Street 1:11985 HERITAGE OAK PL
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-2461
Practice Address - Country:US
Practice Address - Phone:530-886-1397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN27787163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management