Individual
CLARK ALLAN BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
720 WOOD ST, EUREKA, CA 95501-4413
(707) 268-2990
Mailing address
735 STATE ROAD 23, MINERAL POINT, WI 53565-8911
(608) 987-3094
(608) 987-3904
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
130599-30
WI
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
4720618
CA
Other
Enumeration date
05/19/2008
Last updated
01/13/2023
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