MEDICARE: CLARISSA PONCE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	376J00000X	Homemaker	MI
2	372600000X	Adult Companion	MI
3	171W00000X	Contractor

General Provider Information

NPI Number	:	1255221347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARISSA PONCE

Provider Business Mailing Address
First Line	:	1101 W DALE AVE
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49441-2248
Country	:	US
Telephone Number	:	231-343-8338
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 W DALE AVE
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49441-2248
Country	:	US
Telephone Number	:	231-855-8042
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2025
Last Update Date	:	01/20/2026

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Directions to “ CLARISSA PONCE ” Practice Location

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