Provider Demographics
NPI:1174653901
Name:DARR, CLARISSA MCCUDDEN (RN)
Entity Type:Individual
Prefix:MS
First Name:CLARISSA
Middle Name:MCCUDDEN
Last Name:DARR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:15500 VILLISCA TER
Mailing Address - Street 2:
Mailing Address - City:DERWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20855-2711
Mailing Address - Country:US
Mailing Address - Phone:301-762-3557
Mailing Address - Fax:
Practice Address - Street 1:1434 PORTER ST
Practice Address - Street 2:BARQUIST CLINC, FT DETRICK
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-9254
Practice Address - Country:US
Practice Address - Phone:301-619-8096
Practice Address - Fax:301-619-2064
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN37188363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health