Provider Demographics
NPI:1104088764
Name:CLIFTON, IRENE P
Entity type:Individual
Prefix:MS
First Name:IRENE
Middle Name:P
Last Name:CLIFTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:P
Other - Last Name:GALVAN-CLIFTON
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3580 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98418-7915
Mailing Address - Country:US
Mailing Address - Phone:253-798-6130
Mailing Address - Fax:253-798-4493
Practice Address - Street 1:3580 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98418-7915
Practice Address - Country:US
Practice Address - Phone:253-798-6130
Practice Address - Fax:253-798-4493
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00042628164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse