Provider Demographics
NPI:1710004015
Name:CLIFFORD, KATHERINE A (NP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:A
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-2650
Mailing Address - Country:US
Mailing Address - Phone:978-465-7719
Mailing Address - Fax:
Practice Address - Street 1:1 WALLACE BASHAW WAY STE 2003
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3879
Practice Address - Country:US
Practice Address - Phone:978-465-7719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA171621363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner