Provider Demographics
NPI:1740002013
Name:BAQUERO, CLARISSA A (RN)
Entity type:Individual
Prefix:MRS
First Name:CLARISSA
Middle Name:A
Last Name:BAQUERO
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 1:24 LIPPERT DR
Mailing Address - Street 2:
Mailing Address - City:NEW HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:10958-3401
Mailing Address - Country:US
Mailing Address - Phone:646-321-1236
Mailing Address - Fax:
Practice Address - Street 1:24 LIPPERT DR
Practice Address - Street 2:
Practice Address - City:NEW HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:10958-3401
Practice Address - Country:US
Practice Address - Phone:646-321-1236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY748764163WS0121X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery