Provider Demographics
NPI:1700322302
Name:CLAVELL, CARMEN AMPARO (RN)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:AMPARO
Last Name:CLAVELL
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:D202 CALLE 1
Mailing Address - Street 2:URB JARDINES DEL CARIBE
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728
Mailing Address - Country:US
Mailing Address - Phone:787-810-2312
Mailing Address - Fax:
Practice Address - Street 1:D202 CALLE 1
Practice Address - Street 2:URB JARDINES DEL CARIBE
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728
Practice Address - Country:US
Practice Address - Phone:787-810-2312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-06
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR31875163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse