Provider Demographics
NPI:1811710205
Name:CLAUS, LISA K
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:CLAUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 VIRGINIA AVE APT D
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-3953
Mailing Address - Country:US
Mailing Address - Phone:240-744-0674
Mailing Address - Fax:
Practice Address - Street 1:1 TECHNOLOGY DR STE 1104
Practice Address - Street 2:
Practice Address - City:FROSTBURG
Practice Address - State:MD
Practice Address - Zip Code:21532-2499
Practice Address - Country:US
Practice Address - Phone:240-744-0674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRSA-02647374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide