Individual
RONALD SEVIER CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
8800 N TRYON ST, CHARLOTTE, NC 28262-3300
(704) 863-5665
(704) 863-5848
Mailing address
5025 AIRPORT CENTER PKWY BLDG L, CHARLOTTE, NC 28208-5885
(704) 512-7105
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
66013
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NAN647
—
SC
Enumeration date
06/16/2006
Last updated
12/12/2017
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