Provider Demographics
NPI:1225213382
Name:CLAWSON, WANDA SUSIE (CST)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:SUSIE
Last Name:CLAWSON
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8433 HARCOURT RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2190
Mailing Address - Country:US
Mailing Address - Phone:317-583-7600
Mailing Address - Fax:317-583-7601
Practice Address - Street 1:8433 HARCOURT RD
Practice Address - Street 2:SUITE 100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2190
Practice Address - Country:US
Practice Address - Phone:317-583-7600
Practice Address - Fax:317-583-7601
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN050801246XC2903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular Specialist