Provider Demographics
NPI:1730491291
Name:AUSTIN, CLIFFORD (RN)
Entity Type:Individual
Prefix:MR
First Name:CLIFFORD
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17544 MUIRLAND ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-2711
Mailing Address - Country:US
Mailing Address - Phone:313-864-1772
Mailing Address - Fax:
Practice Address - Street 1:17544 MUIRLAND ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-2711
Practice Address - Country:US
Practice Address - Phone:313-864-1772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704151939163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse