Provider Demographics
NPI:1376895748
Name:HARGRO, CLARESE ELASHA
Entity Type:Individual
Prefix:MS
First Name:CLARESE
Middle Name:ELASHA
Last Name:HARGRO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CLARESE
Other - Middle Name:ELASHA
Other - Last Name:HARGRO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:23 HOLLAND PL
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14209-1933
Mailing Address - Country:US
Mailing Address - Phone:716-715-6105
Mailing Address - Fax:
Practice Address - Street 1:23 HOLLAND PL
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-1933
Practice Address - Country:US
Practice Address - Phone:716-715-6105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304698164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse