Provider Demographics
NPI:1457678617
Name:HUGHES, CLIFFORD EUGENE (CRNA)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:EUGENE
Last Name:HUGHES
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1081 N CHINA LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-3130
Mailing Address - Country:US
Mailing Address - Phone:760-499-3899
Mailing Address - Fax:760-499-3393
Practice Address - Street 1:26 BOOTLEGGER ROAD
Practice Address - Street 2:
Practice Address - City:HIGH ROLLS MOUNTAIN PARK
Practice Address - State:NM
Practice Address - Zip Code:88325-0512
Practice Address - Country:US
Practice Address - Phone:916-479-3268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-73102163W00000X
NM01086367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse