Healthcare Provider Details

I. General information

NPI: 1306111893
Provider Name (Legal Business Name): MAREY SUSAN CLAUSEN-BETZ RN, CSW, BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARI CLAUSEN-BETZ RN, CSW, BS

II. Dates (important events)

Enumeration Date: 03/15/2012
Last Update Date: 03/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 ST. ANDREW ST. STE 100
LA CROSSE WI
54603-2378
US

IV. Provider business mailing address

2408 RISTOW CT
LA CROSSE WI
54601-7647
US

V. Phone/Fax

Practice location:
  • Phone: 608-785-6266
  • Fax:
Mailing address:
  • Phone: 608-790-6632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number165811-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: