Individual
MRS. VIVIANNE MURIEL CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
WHNP
Contact information
Practice address
7155 E 38TH AVE, DENVER, CO 80207-1630
(303) 321-7526
(303) 861-0268
Mailing address
7155 E 38TH AVE, DENVER, CO 80207-1630
(303) 321-7526
(303) 861-0268
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
CNP-01603
NM
363LW0102X
Women's Health Nurse Practitioner
NP-291A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010029449
BLUE SHIELD
ID
05
—
41150783
—
NM
05
—
805824600
—
ID
01
—
NPRU3
BLUE CROSS
ID
Enumeration date
10/03/2005
Last updated
11/03/2016
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