Healthcare Provider Details

I. General information

NPI: 1487291118
Provider Name (Legal Business Name): CARISA ELENA CLIFFORD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2019
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 MOHAWK TRAIL
GREENFIELD MA
01302
US

IV. Provider business mailing address

PO BOX 1301
GREENFIELD MA
01302-1301
US

V. Phone/Fax

Practice location:
  • Phone: 413-475-3275
  • Fax:
Mailing address:
  • Phone: 413-475-3275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN2265811
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: