Provider Demographics
NPI:1447934658
Name:CLAUSEN, BENJAMIN (CRNA)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:CLAUSEN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 BRACKETT AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4677
Mailing Address - Country:US
Mailing Address - Phone:715-598-1711
Mailing Address - Fax:
Practice Address - Street 1:1000 OAKLEAF WAY
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720-2246
Practice Address - Country:US
Practice Address - Phone:715-831-8130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-09
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI229970-30367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered