Provider Demographics
NPI:1255163523
Name:CLIFFORD, MARIA COLLEEN (RN)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:COLLEEN
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1271 FAIRWAY 7
Mailing Address - Street 2:
Mailing Address - City:MACEDON
Mailing Address - State:NY
Mailing Address - Zip Code:14502-9391
Mailing Address - Country:US
Mailing Address - Phone:716-725-3511
Mailing Address - Fax:
Practice Address - Street 1:1271 FAIRWAY 7
Practice Address - Street 2:
Practice Address - City:MACEDON
Practice Address - State:NY
Practice Address - Zip Code:14502-9391
Practice Address - Country:US
Practice Address - Phone:716-725-3511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY630712-01251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care