Provider Demographics
NPI:1932660115
Name:CLUSE, DAYNESSES ELIZABETH (BA, LPN)
Entity Type:Individual
Prefix:MS
First Name:DAYNESSES
Middle Name:ELIZABETH
Last Name:CLUSE
Suffix:
Gender:F
Credentials:BA, LPN
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 92052
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70509-2052
Mailing Address - Country:US
Mailing Address - Phone:337-739-4006
Mailing Address - Fax:
Practice Address - Street 1:2229 MOSS ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-2123
Practice Address - Country:US
Practice Address - Phone:337-739-4006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA20110126164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty