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Individual
MR. CHARLES PATRICK CLARK
Active
Individual
MR. CHARLES PATRICK CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
151205
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8052336
—
NC
05
—
986074426A
—
GA
01
—
P00289782
RAILROAD MEDICARE
NC
Enumeration date
07/20/2006
Last updated
07/09/2009
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