Provider Demographics
NPI:1891995544
Name:BIGELOW, CLARA SUE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CLARA
Middle Name:SUE
Last Name:BIGELOW
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:CLARA
Other - Middle Name:SUE
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:38 FRONT ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4712
Mailing Address - Country:US
Mailing Address - Phone:607-722-6461
Mailing Address - Fax:607-771-0116
Practice Address - Street 1:38 FRONT ST
Practice Address - Street 2:SUITE D
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4712
Practice Address - Country:US
Practice Address - Phone:607-722-6461
Practice Address - Fax:607-771-0116
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2234991164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02589779Medicaid