Individual
NICHOLAS CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
350 CITY VIEW DR STE 206, EVANSTON, WY 82930
(307) 789-7915
Mailing address
350 CITY VIEW DR STE 206, EVANSTON, WY 82930-5326
(307) 789-7915
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
8096
WY
Other
Enumeration date
04/26/2018
Last updated
05/29/2018
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