1548338841 NPI number — CHARLOTTE ANN CLAUSEN MD

Table of content: CHARLOTTE ANN CLAUSEN MD (NPI 1548338841)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548338841 NPI number — CHARLOTTE ANN CLAUSEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLAUSEN
Provider First Name:
CHARLOTTE
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CLOCK
Provider Other First Name:
CHARLOTTE
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1548338841
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3355 RIVERBEND DR
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97477-8800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-349-7600
Provider Business Mailing Address Fax Number:
541-246-2353

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3355 RIVERBEND DR
Provider Second Line Business Practice Location Address:
STE 210
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97477-8800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-349-7600
Provider Business Practice Location Address Fax Number:
541-246-2353
Provider Enumeration Date:
12/04/2006

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: 207VM0101X , with the licence number:  MD 27457 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 274319 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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