Provider Demographics
NPI:1548874530
Name:CLAYTON, KAREN LOLITA
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:LOLITA
Last Name:CLAYTON
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 1:136 NORTHWEST DR
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-6657
Mailing Address - Country:US
Mailing Address - Phone:701-425-9737
Mailing Address - Fax:
Practice Address - Street 1:136 NORTHWEST DR
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-6657
Practice Address - Country:US
Practice Address - Phone:701-425-9737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-07
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist