Individual
MS. NICOLE LORRAINE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
1010 W WASHINGTON ST, BOISE, ID 83702-5446
(208) 854-4270
(208) 854-4271
Mailing address
6472 W PARAPET DR, BOISE, ID 83714-8849
(208) 377-3597
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-208
ID
Other
Enumeration date
06/26/2006
Last updated
07/08/2007
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