Provider Demographics
NPI:1235772385
Name:CLOUTIER, JOAN MARY (RN)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:MARY
Last Name:CLOUTIER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 CASS ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-4157
Mailing Address - Country:US
Mailing Address - Phone:231-649-0099
Mailing Address - Fax:231-935-1496
Practice Address - Street 1:3205 SUPPLY RD
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49696-9486
Practice Address - Country:US
Practice Address - Phone:231-649-0099
Practice Address - Fax:231-935-1496
Is Sole Proprietor?:No
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704192100163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice