Provider Demographics
NPI:1700970225
Name:CLEMENTS, JOANNE VANDEVALK (MS, ACNP)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:VANDEVALK
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:MS, ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX SON
Mailing Address - Street 2:601 ELMWOOD AVE
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-273-2520
Mailing Address - Fax:585-273-1270
Practice Address - Street 1:601 ELMWOOD AVE, BOX 604
Practice Address - Street 2:PREADMISSION EVALUATION CENTER
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642
Practice Address - Country:US
Practice Address - Phone:585-275-6011
Practice Address - Fax:585-244-7271
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY430080363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care