Provider Demographics
NPI:1316263783
Name:CLEARWATER, SUSAN BETH (RN, BSN)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:BETH
Last Name:CLEARWATER
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-2069
Mailing Address - Country:US
Mailing Address - Phone:812-335-0640
Mailing Address - Fax:812-333-0961
Practice Address - Street 1:2401 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-2069
Practice Address - Country:US
Practice Address - Phone:812-335-0640
Practice Address - Fax:812-333-0961
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-10
Last Update Date:2010-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28103070A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse