Provider Demographics
NPI:1699892133
Name:CLIFTON, GINGER LADONNA
Entity type:Individual
Prefix:
First Name:GINGER
Middle Name:LADONNA
Last Name:CLIFTON
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 1:811 S ROBERTS AVE
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-4827
Mailing Address - Country:US
Mailing Address - Phone:405-295-1667
Mailing Address - Fax:
Practice Address - Street 1:200 N CHOCTAW AVE
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-2624
Practice Address - Country:US
Practice Address - Phone:405-262-6662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator