Provider Demographics
NPI:1700929254
Name:CLENDENNING, DEBORAH J (PA-C)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:J
Last Name:CLENDENNING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11245 HURON ST
Mailing Address - Street 2:WESTMINSTER FACILITY
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-2806
Mailing Address - Country:US
Mailing Address - Phone:303-457-6433
Mailing Address - Fax:303-457-6257
Practice Address - Street 1:11245 HURON ST
Practice Address - Street 2:WESTMINSTER FACILITY
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-2806
Practice Address - Country:US
Practice Address - Phone:303-636-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO50207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
002400OtherKAISER-COMMERCIAL NUMBER