Clarissa Victoria Trader

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

0002097361 Issued in VA

Practice address

1532 Ocean Hwy
Pocomoke City, MD 21851-3023

Phone

(443) 437-7128

Fax

(443) 437-7131

NPI assigned

Apr 28, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Open Arms & Hearts Health Services

  • Methadone Clinic
  • Pocomoke City, MD
  • NPI 1992355465
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1619568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619568000000",
    "number": "1669054615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3564 NAVIGATOR DR",
            "city": "GREENBACKVILLE",
            "state": "VA",
            "postal_code": "233562508",
            "telephone_number": "757-894-8941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1532 OCEAN HWY",
            "city": "POCOMOKE CITY",
            "state": "MD",
            "postal_code": "218513023",
            "telephone_number": "443-437-7128",
            "fax_number": "443-437-7131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRADER",
        "first_name": "CLARISSA",
        "middle_name": "VICTORIA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-28",
        "last_updated": "2021-04-28",
        "certification_date": "2021-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "VA",
            "license": "0002097361",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "98.233.194.224",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1532 Ocean Hwy",
            "city": "Pocomoke City",
            "state": "MD",
            "country_code": "US",
            "postal_code": "218513023",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Tidalhealth Primary Care, LLC
• Tidalhealth Specialty Care, LLC
• Tidalhealth Specialty Care, LLC
• Kandyce Paige Tolbert, LCPC
• Shelonda Latisha Townsend, LCSW
• Wal-Mart Stores East LP (Walmart Pharmacy 10-2514)
• Wal-Mart Stores East, LP (Vision Center 30-2514)
• Angelique Ward
• Howard William Ward III, CRNP
• Marietta J Ward, LPN

• Licensed Practical Nurse in Pocomoke City, MD
• Providers in Pocomoke City, MD by specialty
• Licensed Practical Nurse in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.