1306111893 NPI number — MS. MAREY SUSAN CLAUSEN-BETZ RN, CSW, BS

Table of content: MS. MAREY SUSAN CLAUSEN-BETZ RN, CSW, BS (NPI 1306111893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306111893 NPI number — MS. MAREY SUSAN CLAUSEN-BETZ RN, CSW, BS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLAUSEN-BETZ
Provider First Name:
MAREY
Provider Middle Name:
SUSAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN, CSW, BS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CLAUSEN-BETZ
Provider Other First Name:
MARI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN, CSW, BS
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1306111893
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2408 RISTOW CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA CROSSE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54601-7647
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-790-6632
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1407 ST. ANDREW ST.
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
LA CROSSE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54603-2378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-785-6266
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WC1500X , with the licence number:  165811-30 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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