Individual
SHAWNA REBECCA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
400 VIRGINIA AVE STE 201, NORTH BEND, OR 97459-3444
(541) 751-0357
(541) 751-9985
Mailing address
PO BOX 1121, ROSEBURG, OR 97470-0254
(541) 672-2691
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
200742753RN
CA
Other
Enumeration date
06/15/2021
Last updated
06/15/2021
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