Provider Demographics
NPI:1033392444
Name:CLOUSE, JACQUELINE LOUISE (RN)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:LOUISE
Last Name:CLOUSE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:JACQUELINE
Other - Middle Name:LOUISE
Other - Last Name:KNELLINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:301 MCGHEE ST
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-6811
Mailing Address - Country:US
Mailing Address - Phone:865-983-4582
Mailing Address - Fax:865-681-0079
Practice Address - Street 1:301 MCGHEE ST
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-6811
Practice Address - Country:US
Practice Address - Phone:865-983-4582
Practice Address - Fax:865-681-0079
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000075589163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse