Provider Demographics
NPI:1144255761
Name:CLYBURN, ARLINE LOUISE (MN,CS,RN)
Entity type:Individual
Prefix:MS
First Name:ARLINE
Middle Name:LOUISE
Last Name:CLYBURN
Suffix:
Gender:F
Credentials:MN,CS,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3086 INDIAN MESA DR
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1124
Mailing Address - Country:US
Mailing Address - Phone:805-493-0978
Mailing Address - Fax:
Practice Address - Street 1:86 LONG CT
Practice Address - Street 2:SUITE A
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-7418
Practice Address - Country:US
Practice Address - Phone:805-493-0978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 186993163WP0807X
CA364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
Not Answered364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACNS114Medicare ID - Type Unspecified