Provider Demographics
NPI:1568693281
Name:CLIFTON, SUZANNE THERESA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:THERESA
Last Name:CLIFTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 OSWEGO ST
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-1130
Mailing Address - Country:US
Mailing Address - Phone:315-635-6811
Mailing Address - Fax:
Practice Address - Street 1:101 OSWEGO ST
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-1130
Practice Address - Country:US
Practice Address - Phone:315-635-6811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6650423164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse