Provider Demographics
NPI:1841718939
Name:CYPRESS, CLARICE PINKY
Entity type:Individual
Prefix:
First Name:CLARICE
Middle Name:PINKY
Last Name:CYPRESS
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 1:681 GILPARK RD
Mailing Address - Street 2:
Mailing Address - City:DENDRON
Mailing Address - State:VA
Mailing Address - Zip Code:23839-2005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:681GILPARK ROAD
Practice Address - Street 2:
Practice Address - City:DENDRON
Practice Address - State:VA
Practice Address - Zip Code:23839
Practice Address - Country:US
Practice Address - Phone:757-522-9658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health