Basic Information
| Provider Information | |||||||||
| NPI: | 1457683567 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLIFFORD | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | MALINDA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | ANP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2019 TWO ROD RD | ||||||||
| Address2: | |||||||||
| City: | MARILLA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141029702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7162003009 | ||||||||
| FaxNumber: | 7166527075 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 MERIDIAN CTR | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146183981 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5854633100 | ||||||||
| FaxNumber: | 5854633105 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2010 | ||||||||
| LastUpdateDate: | 02/11/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 392788 | NY | N | Nursing Service Providers | Registered Nurse | 363LA2200X | 305329 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.