Provider Demographics
NPI:1194111898
Name:CLUTE CLINIC
Entity type:Organization
Organization Name:CLUTE CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KAYLEEN
Authorized Official - Middle Name:WEINMAN
Authorized Official - Last Name:CLUTE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP, APRN
Authorized Official - Phone:202-714-2417
Mailing Address - Street 1:37 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-3715
Mailing Address - Country:US
Mailing Address - Phone:202-714-2417
Mailing Address - Fax:410-315-8380
Practice Address - Street 1:1315 31 ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007
Practice Address - Country:US
Practice Address - Phone:202-714-2417
Practice Address - Fax:410-315-8380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1026084363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty