Individual
MRS. REBECCA SUE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA, MS, BSN
Contact information
Practice address
1015 UNION ST, BOONE, IA 50036-4821
(515) 370-1054
Mailing address
411 ASHWOOD CT, BOONE, IA 50036-7190
(515) 370-1054
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
113814
IA
367500000X
Certified Registered Nurse Anesthetist
Primary
074139
IA
Other
Enumeration date
08/22/2006
Last updated
10/17/2009
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