Provider Demographics
NPI:1821363532
Name:CLAUSON, WADE BROR (LPN)
Entity Type:Individual
Prefix:
First Name:WADE
Middle Name:BROR
Last Name:CLAUSON
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7411 METZGER AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:JBER
Mailing Address - State:AK
Mailing Address - Zip Code:99506
Mailing Address - Country:US
Mailing Address - Phone:907-330-9779
Mailing Address - Fax:
Practice Address - Street 1:7411 METZGER AVE UNIT B
Practice Address - Street 2:
Practice Address - City:JBER
Practice Address - State:AK
Practice Address - Zip Code:99506-2022
Practice Address - Country:US
Practice Address - Phone:907-330-9779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLEMT530361146N00000X
AK6820164W00000X
FLPN5199765164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic