Provider Demographics
NPI:1942978499
Name:DAVIS-IGLE, CLARISSA
Entity Type:Individual
Prefix:MS
First Name:CLARISSA
Middle Name:
Last Name:DAVIS-IGLE
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 1:3147 EDSON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-3126
Mailing Address - Country:US
Mailing Address - Phone:718-324-5935
Mailing Address - Fax:
Practice Address - Street 1:3147 EDSON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-3126
Practice Address - Country:US
Practice Address - Phone:718-324-5935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY543643163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool