Provider Demographics
NPI:1659927630
Name:KLAUDER, MARY LOUISE (RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LOUISE
Last Name:KLAUDER
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:PO BOX 383975
Mailing Address - Street 2:
Mailing Address - City:WAIKOLOA
Mailing Address - State:HI
Mailing Address - Zip Code:96738-3975
Mailing Address - Country:US
Mailing Address - Phone:808-333-2853
Mailing Address - Fax:
Practice Address - Street 1:68-3890 PANIOLO AVE
Practice Address - Street 2:
Practice Address - City:WAIKOLOA
Practice Address - State:HI
Practice Address - Zip Code:96738-5246
Practice Address - Country:US
Practice Address - Phone:808-333-2853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-83517163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool