Individual
PAULA ANN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
25825 VERMONT AVE, HARBOR CITY, CA 90710-3518
(310) 920-9459
Mailing address
5130 E BURNETT ST, LONG BEACH, CA 90815-1905
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
556632
CA
367500000X
Certified Registered Nurse Anesthetist
Primary
3548
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1261768
CAQH
—
01
—
I9551971
AETNA
—
Enumeration date
12/10/2007
Last updated
09/26/2024
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