Clemens, Lisa M

Clemens, Lisa M is an individual health care provider with primary practice located at 2200 Randallia Dr , Fort Wayne IN 46805-4638. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Clemens, Lisa M can be contacted via phone (260) 373-4000.

Contact Information

Primary practice address
2200 Randallia Dr Fort Wayne IN 46805-4638
Phone: (260) 373-4000
Fax: (260) 482-4442
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 10001224A Indiana

Profile Details

NPI number 1215244421
LBN Legal business name Clemens, Lisa M
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 9th, 2010
Last updated Oct 19th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1215244421 NPPES
Indiana Other 000000680854 ANTHEM
Indiana Other P00984506 ANTHEM

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