Provider Demographics
NPI:1902605777
Name:CLARKSON, RAVADA DELORES
Entity type:Individual
Prefix:
First Name:RAVADA
Middle Name:DELORES
Last Name:CLARKSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 E SUNSET RD APT 2142
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-4957
Mailing Address - Country:US
Mailing Address - Phone:707-712-7236
Mailing Address - Fax:
Practice Address - Street 1:2255 E SUNSET RD APT 2142
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-4957
Practice Address - Country:US
Practice Address - Phone:707-712-7236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-12
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant