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General NPI Number Information
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NPI Number | 1871570143
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Entity Type | Individual
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Provider Name | MARY J CLAUSON FNP
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Gender | Female
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Dates
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Enumeration Date | 12/28/2005
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Last Update Date | 11/19/2010
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Provider Practice Location Address
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Address Line | 20 GLENLAKE PARKWAY KAISER PERMANENTE GLENLAKE
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City | ATLANTA
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State | GA
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Zip | 30328
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Country | US
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Telephone | 404-686-7435
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Fax | 404-686-4473
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Provider Business Mailing Address
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Address Line | 3495 PIEDMONT ROAD, NE THE SOUTHEAST PERMANENTE MEDICAL GROUP
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City | ATLANTA
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State | GA
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Zip | 30305
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Country | US
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Telephone | 404-551-4948
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Fax | 404-806-1779
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN082935
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 367H00000X
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Taxonomy Name | Anesthesiologist Assistant
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License Number | 633458
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License Number State | TX
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