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Individual
TIMETRA DIANE CLARK
Active
Individual
TIMETRA DIANE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-BC
Taxonomy
Speciality
Code
Description
License number
State
163WN0300X
Nephrology Registered Nurse
041436444
IL
163WN0300X
Nephrology Registered Nurse
9562544
FL
363L00000X
Nurse Practitioner
209024791
IL
363LF0000X
Family Nurse Practitioner
Primary
209024791
IL
Other
Enumeration date
04/01/2022
Last updated
04/01/2022
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