Healthcare Provider Details

I. General information

NPI: 1336962737
Provider Name (Legal Business Name): MARJORIE ANN CLOUSE RN, CEN, SANE-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARJORIE ANN PFAFF

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 E DISCOVERY PKWY
BLOOMINGTON IN
47408-9059
US

IV. Provider business mailing address

2651 E DISCOVERY PKWY
BLOOMINGTON IN
47408-9059
US

V. Phone/Fax

Practice location:
  • Phone: 812-918-3108
  • Fax:
Mailing address:
  • Phone: 812-918-3108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number28249343A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: