Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 38475 | SC |
N | 207YP0228X | Pediatric Otolaryngology | MT195945 | PA |
NPI | 1962638502 |
---|---|
Provider Name | Clarice Seifert Clemmens |
First Address | Charlotte, NC 28275-1461 |
Second Address | Charleston, SC 29425-8908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2009 |
Last Update Date | 14/09/2015 |