Provider Demographics
NPI:1487291118
Name:CLIFFORD, CARISA ELENA (RN)
Entity type:Individual
Prefix:
First Name:CARISA
Middle Name:ELENA
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1301
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01302-1301
Mailing Address - Country:US
Mailing Address - Phone:413-475-3275
Mailing Address - Fax:
Practice Address - Street 1:390 MOHAWK TRAIL
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01302
Practice Address - Country:US
Practice Address - Phone:413-475-3275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2265811163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics