Individual
MADELINE GRACE CLEMENTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4035 MIMOSA DR, COLUMBUS, IN 47201-7200
(831) 786-5904
(317) 867-5321
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10004926A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/22/2025
Last updated
08/13/2025
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