Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 0024171614 | VA |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 0024171614 | VA |
NPI | 1306257803 |
---|---|
Provider Name | Michelle A Clements |
First Address | Roanoke, VA 24014-3121 |
Second Address | Roanoke, VA 24012-1303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2014 |
Last Update Date | 21/04/2016 |