Individual
THOMAS BENNETT CLARK JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1959 NE PACIFIC ST, SEATTLE, WA 98195-0001
(206) 520-5000
Mailing address
PO BOX 50095, SEATTLE, WA 98145-5095
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP60093669
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2010101
—
WA
Enumeration date
11/13/2006
Last updated
08/15/2024
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