Provider Demographics
NPI:1306111893
Name:CLAUSEN-BETZ, MAREY SUSAN (RN, CSW, BS)
Entity type:Individual
Prefix:MS
First Name:MAREY
Middle Name:SUSAN
Last Name:CLAUSEN-BETZ
Suffix:
Gender:F
Credentials:RN, CSW, BS
Other - Prefix:
Other - First Name:MARI
Other - Middle Name:
Other - Last Name:CLAUSEN-BETZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, CSW, BS
Mailing Address - Street 1:2408 RISTOW CT
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-7647
Mailing Address - Country:US
Mailing Address - Phone:608-790-6632
Mailing Address - Fax:
Practice Address - Street 1:1407 ST. ANDREW ST.
Practice Address - Street 2:STE 100
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54603-2378
Practice Address - Country:US
Practice Address - Phone:608-785-6266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI165811-30163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health