Provider Demographics
NPI:1063784502
Name:CLIFTON, SHAE LYNN (LVN)
Entity type:Individual
Prefix:MRS
First Name:SHAE
Middle Name:LYNN
Last Name:CLIFTON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2090 POPLAR RD APT 211
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-2376
Mailing Address - Country:US
Mailing Address - Phone:530-586-0963
Mailing Address - Fax:
Practice Address - Street 1:2090 POPLAR RD APT 21192058
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-2374
Practice Address - Country:US
Practice Address - Phone:530-586-0963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-30
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA260382164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse