Individual
DESA MARIAH CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
2560 N HEALTHY WAY, FREMONT, NE 68025-2315
(402) 941-7245
Mailing address
605 E THOMSEN ST, FREMONT, NE 68025-9235
(402) 317-0797
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
64709
NE
363LF0000X
Family Nurse Practitioner
Primary
113657
NE
Other
Enumeration date
04/22/2021
Last updated
07/07/2021
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