Provider Demographics
NPI:1275275323
Name:CLIFFORD, MARTHA DIANN (APRN, FNP-BC, CNP)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:DIANN
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:APRN, FNP-BC, CNP
Other - Prefix:MRS
Other - First Name:MARTHA
Other - Middle Name:DIANN
Other - Last Name:CLIFFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN, FNP-BC, CNP
Mailing Address - Street 1:9043 LONGSTONE DR
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-8439
Mailing Address - Country:US
Mailing Address - Phone:740-953-1332
Mailing Address - Fax:
Practice Address - Street 1:9043 LONGSTONE DR
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-8439
Practice Address - Country:US
Practice Address - Phone:740-953-1332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-10
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0030974363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily