Provider Demographics
NPI:1245210939
Name:ERNEST, CLARISSA ELIZABETH (RN, MPA, MDIV)
Entity Type:Individual
Prefix:MS
First Name:CLARISSA
Middle Name:ELIZABETH
Last Name:ERNEST
Suffix:
Gender:F
Credentials:RN, MPA, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COMMANDANT CG 1122 US COAST GUARD
Mailing Address - Street 2:2100 2ND ST SW STOP 7000
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20593-7000
Mailing Address - Country:US
Mailing Address - Phone:757-628-4924
Mailing Address - Fax:757-628-4337
Practice Address - Street 1:COMMANDANT CG 1122 US COAST GUARD
Practice Address - Street 2:2100 2ND ST SW STOP 7000
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20593-7000
Practice Address - Country:US
Practice Address - Phone:757-628-4924
Practice Address - Fax:757-628-4337
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001137567163W00000X, 163WA2000X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC0400XNursing Service ProvidersRegistered NurseCase Management