Provider Demographics
NPI:1326801572
Name:CLIFFORD, EVAN R
Entity Type:Individual
Prefix:MR
First Name:EVAN
Middle Name:R
Last Name:CLIFFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 CHESTNUT LN APT 1A
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3850
Mailing Address - Country:US
Mailing Address - Phone:740-438-7953
Mailing Address - Fax:
Practice Address - Street 1:1570 E MAIN ST LOT 18
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3470
Practice Address - Country:US
Practice Address - Phone:740-438-7953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide