Provider Demographics
NPI:1518436260
Name:CALDWELL, CLARISSA
Entity Type:Individual
Prefix:MRS
First Name:CLARISSA
Middle Name:
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 CARMICHAEL RD APT 2207
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-1813
Mailing Address - Country:US
Mailing Address - Phone:334-777-7294
Mailing Address - Fax:
Practice Address - Street 1:5600 CARMICHAEL RD APT 2207
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-1813
Practice Address - Country:US
Practice Address - Phone:334-777-7294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-23
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL201815234374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide