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Individual

CLAYTON MICHAEL CLARK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
307 TRENT DR, DURHAM, NC 27710-3038
(919) 684-3786
Mailing address
1428 IDA ST APT K, DURHAM, NC 27705-3331

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
275012
NC
367500000X
Certified Registered Nurse Anesthetist
Primary
AP143683
TX

Other

Enumeration date
06/05/2019
Last updated
11/19/2019
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