Provider Demographics
NPI:1336962737
Name:CLOUSE, MARJORIE ANN (RN, CEN, SANE-A)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:ANN
Last Name:CLOUSE
Suffix:
Gender:F
Credentials:RN, CEN, SANE-A
Other - Prefix:
Other - First Name:MARJORIE
Other - Middle Name:ANN
Other - Last Name:PFAFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2651 E DISCOVERY PKWY
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408-9059
Mailing Address - Country:US
Mailing Address - Phone:812-918-3108
Mailing Address - Fax:
Practice Address - Street 1:2651 E DISCOVERY PKWY
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47408-9059
Practice Address - Country:US
Practice Address - Phone:812-918-3108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28249343A163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency