Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | NP15091 | CA |
Y | 363LA2100X | Nurse Practitioner - Acute Care | NP15091 | CA |
NPI | 1033141650 |
---|---|
Provider Name | Heidi Lynn Clausen |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Los Angeles, CA 90024-6970 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 11/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q36067 | (02) | CA |
RN554584 | (05) | CA |