Healthcare Provider Details

I. General information

NPI: 1245210939
Provider Name (Legal Business Name): CLARISSA ELIZABETH ERNEST RN, MPA, MDIV
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COMMANDANT CG 1122 US COAST GUARD 2100 2ND ST SW STOP 7000
WASHINGTON DC
20593-7000
US

IV. Provider business mailing address

COMMANDANT CG 1122 US COAST GUARD 2100 2ND ST SW STOP 7000
WASHINGTON DC
20593-7000
US

V. Phone/Fax

Practice location:
  • Phone: 757-628-4924
  • Fax: 757-628-4337
Mailing address:
  • Phone: 757-628-4924
  • Fax: 757-628-4337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001137567
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number0001137567
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number0001137567
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: