Individual
CLARK HENDRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1717 S J ST, TACOMA, WA 98405-4933
(844) 364-2778
Mailing address
1717 S J ST, TACOMA, WA 98405-4933
(844) 364-2778
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP60737795
WA
367500000X
Certified Registered Nurse Anesthetist
R 173735-6
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2081364
—
WA
Enumeration date
05/17/2012
Last updated
12/04/2020
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