=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245210939
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CLARISSA ELIZABETH ERNEST RN, MPA, MDIV
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2006
-----------------------------------------------------
Last Update Date | 08/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | COMMANDANT CG 1122 US COAST GUARD 2100 2ND ST SW STOP 7000
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20593-7000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-628-4924
-----------------------------------------------------
Fax | 757-628-4337
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | COMMANDANT CG 1122 US COAST GUARD 2100 2ND ST SW STOP 7000
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20593-7000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-628-4924
-----------------------------------------------------
Fax | 757-628-4337
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 0001137567
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163WA2000X
-----------------------------------------------------
Taxonomy Name | Administrator Registered Nurse
-----------------------------------------------------
License Number | 0001137567
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 163WC0400X
-----------------------------------------------------
Taxonomy Name | Case Management Registered Nurse
-----------------------------------------------------
License Number | 0001137567
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------