Provider Demographics
NPI:1659974392
Name:CLIFTON, LUCINDA
Entity Type:Individual
Prefix:
First Name:LUCINDA
Middle Name:
Last Name:CLIFTON
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 1:1291 MOORE RD
Mailing Address - Street 2:
Mailing Address - City:RAVEN
Mailing Address - State:VA
Mailing Address - Zip Code:24639-9049
Mailing Address - Country:US
Mailing Address - Phone:276-210-6962
Mailing Address - Fax:
Practice Address - Street 1:1291 MOORE RD
Practice Address - Street 2:
Practice Address - City:RAVEN
Practice Address - State:VA
Practice Address - Zip Code:24639-9049
Practice Address - Country:US
Practice Address - Phone:276-210-6962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant