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Individual

NICHOLAS E. CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
4605 MACCORKLE AVE SW, SOUTH CHARLESTON, WV 25309-1311
(304) 766-3600
Mailing address
110 ROANE ST, CHARLESTON, WV 25302-2334
(304) 344-0096
(304) 342-4725

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
118087
WV

Other

Enumeration date
06/12/2018
Last updated
06/12/2018
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