Provider Demographics
NPI:1710225677
Name:CLERC, CHRISTINE E (MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:E
Last Name:CLERC
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3503 SAMSON WAY
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68123-4318
Mailing Address - Country:US
Mailing Address - Phone:402-592-2055
Mailing Address - Fax:
Practice Address - Street 1:3503 SAMSON WAY
Practice Address - Street 2:SUITE 108
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68123-4318
Practice Address - Country:US
Practice Address - Phone:402-592-2055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-27
Last Update Date:2013-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1702363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant