Individual
MAR Y LOUISE CLEMSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RNCS
Contact information
Practice address
602 MASSACHUSETTS AVE, NORFOLK, VA 23508-2118
(757) 622-6673
(757) 622-6673
Mailing address
602 MASSACHUSETTS AVE, NORFOLK, VA 23508-2118
(757) 622-6673
(757) 622-6673
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
1193801
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101867
ANTHEM GROUP
VA
01
—
101868
ANTHEM INDIVIDUAL
VA
01
—
C08982
MEDICARE
VA
01
—
P00071810
RAILROAD
VA
Enumeration date
11/28/2007
Last updated
03/26/2008
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