Basic Information
| Provider Information | |||||||||
| NPI: | 1780102269 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLIFFORD | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | REGISTERED NURSE | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 231 E GRAHAM AVE | ||||||||
| Address2: | |||||||||
| City: | PRYOR | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9188251405 | ||||||||
| FaxNumber: | 9188251406 | ||||||||
| Practice Location | |||||||||
| Address1: | 231 E GRAHAM AVE | ||||||||
| Address2: | |||||||||
| City: | PRYOR | ||||||||
| State: | OK | ||||||||
| PostalCode: | 743612436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9188251405 | ||||||||
| FaxNumber: | 9188251406 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | R0090702 | OK | Y | Nursing Service Providers | Registered Nurse |
No ID Information.