Provider Demographics
NPI:1992079040
Name:CLAYSON, CAROLINE (LPN)
Entity type:Individual
Prefix:MISS
First Name:CAROLINE
Middle Name:
Last Name:CLAYSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 6TH ST
Mailing Address - Street 2:(UPPER)
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14605-2454
Mailing Address - Country:US
Mailing Address - Phone:585-966-9107
Mailing Address - Fax:
Practice Address - Street 1:183 6TH ST
Practice Address - Street 2:(UPPER)
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14605-2454
Practice Address - Country:US
Practice Address - Phone:585-966-9107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302291164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse