Provider Demographics
NPI:1639359482
Name:CLARKE, DAFERTI NAARAH (REGISTERED NURSE)
Entity Type:Individual
Prefix:MS
First Name:DAFERTI
Middle Name:NAARAH
Last Name:CLARKE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 E 230TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-4416
Mailing Address - Country:US
Mailing Address - Phone:718-652-0549
Mailing Address - Fax:
Practice Address - Street 1:855 E 230TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-4416
Practice Address - Country:US
Practice Address - Phone:718-652-0549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY570862163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse