Individual
JONATHAN B. CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
164 SUMMIT AVE, PROVIDENCE, RI 02906-2853
(401) 793-4575
Mailing address
333 RICCIUTI DR, APT. 1824, QUINCY, MA 02169-6287
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN00302
RI
367500000X
Certified Registered Nurse Anesthetist
RN277232
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110106160A
—
MA
Enumeration date
02/04/2015
Last updated
09/16/2021
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us