MEDICARE: KAREN CLOUTMAN RCSN

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	163WS0200X	School Registered Nurse	356535	CA

General Provider Information

NPI Number	:	1881187896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN CLOUTMAN RCSN

Provider Business Mailing Address
First Line	:	1811 32ND ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92102-1201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4350 MOUNT EVEREST BLVD RM B-12
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-4847
Country	:	US
Telephone Number	:	858-627-7590
Fax Number	:

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

Provider Enumeration Date	:	06/13/2018
Last Update Date	:	06/13/2018

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