Provider Demographics
NPI:1235739814
Name:JAMES, CLARISSA (LPN)
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:
Last Name:JAMES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ORISKANY FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13425-4144
Mailing Address - Country:US
Mailing Address - Phone:929-232-9510
Mailing Address - Fax:
Practice Address - Street 1:239 MAIN ST
Practice Address - Street 2:
Practice Address - City:ORISKANY FALLS
Practice Address - State:NY
Practice Address - Zip Code:13425-4144
Practice Address - Country:US
Practice Address - Phone:929-232-9510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-31
Last Update Date:2020-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2948671164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse