Provider Demographics
NPI:1497772123
Name:HOUSEMAN, CLARE A (CNS)
Entity Type:Individual
Prefix:
First Name:CLARE
Middle Name:A
Last Name:HOUSEMAN
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 N CENTER DR
Mailing Address - Street 2:STE 141 INTERSTATE CORPORATE CENTER BLDG 11
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502
Mailing Address - Country:US
Mailing Address - Phone:757-466-0700
Mailing Address - Fax:757-461-4826
Practice Address - Street 1:420 N CENTER DR
Practice Address - Street 2:STE 141 INTERSTATE CORPORATE CENTER BLDG 11
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502
Practice Address - Country:US
Practice Address - Phone:757-466-0700
Practice Address - Fax:757-461-4826
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0015000023364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
P31243Medicare UPIN