Provider Demographics
NPI:1770008534
Name:CLARKSON, ELIZABETH R (CNM)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:R
Last Name:CLARKSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:758 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-3303
Mailing Address - Country:US
Mailing Address - Phone:914-471-7433
Mailing Address - Fax:
Practice Address - Street 1:2 TREE FARM RD
Practice Address - Street 2:SUITE A110
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534
Practice Address - Country:US
Practice Address - Phone:609-737-7512
Practice Address - Fax:609-737-0978
Is Sole Proprietor?:No
Enumeration Date:2017-08-13
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25ME00063001367A00000X
NJ26NR16866900163W00000X
367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse