Individual
CHARLES CLARK
Active
Individual
CHARLES CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
RN702962
PA
367500000X
Certified Registered Nurse Anesthetist
Primary
R217337
MD
367500000X
Certified Registered Nurse Anesthetist
RN702962
PA
Other
Enumeration date
01/29/2021
Last updated
06/24/2024
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