Basic Information
| Provider Information | |||||||||
| NPI: | 1033150768 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CLOUTIER | ||||||||
| FirstName: | CLARE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4550 FAUNTLEROY WAY SW | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981263471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063991041 | ||||||||
| FaxNumber: | 3606987002 | ||||||||
| Practice Location | |||||||||
| Address1: | 4550 FAUNTLEROY WAY SW | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981263471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063991041 | ||||||||
| FaxNumber: | 3606987002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2006 | ||||||||
| LastUpdateDate: | 12/02/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA10003159 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 1030913 | 05 | WA | MEDICAID |