Provider Demographics
NPI:1457683567
Name:CLIFFORD, KATHERINE MALINDA (ANP)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:MALINDA
Last Name:CLIFFORD
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2019 TWO ROD RD
Mailing Address - Street 2:
Mailing Address - City:MARILLA
Mailing Address - State:NY
Mailing Address - Zip Code:14102-9702
Mailing Address - Country:US
Mailing Address - Phone:716-200-3009
Mailing Address - Fax:716-652-7075
Practice Address - Street 1:300 MERIDIAN CTR
Practice Address - Street 2:SUITE 320
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3981
Practice Address - Country:US
Practice Address - Phone:585-463-3100
Practice Address - Fax:585-463-3105
Is Sole Proprietor?:No
Enumeration Date:2010-02-01
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY392788163W00000X
NY305329363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse