MEDICARE: DEBRA S CLAUSEN NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	316918	CA

General Provider Information

NPI Number	:	1730200361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA S CLAUSEN NP

Provider Business Mailing Address
First Line	:	13611 MESA CREST DR
Second Line	:
City	:	YUCAIPA
State	:	CA
Zip	:	92399-5821
Country	:	US
Telephone Number	:	909-446-8335
Fax Number	:	909-558-3023

Provider Business Practice Location Address
First Line	:	11285 MOUNTAIN VIEW AVE
Second Line	:	SUITE 40
City	:	LOMA LINDA
State	:	CA
Zip	:	92354-3862
Country	:	US
Telephone Number	:	909-558-3036
Fax Number	:	909-558-3023

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	07/08/2007

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