Individual
MARY ANN CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1200 J D ANDERSON DR, MORGANTOWN, WV 26505-3494
(304) 598-1200
Mailing address
PO BOX 711841, MID ATLANTIC ANESTHESIA CONSULTANTS, COLUMBUS, OH 43271-0001
(304) 346-9400
(304) 345-7320
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
033774
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001706470
MSBCBS
WV
01
—
001719096
MSBCBS
WV
05
—
0065884000
—
WV
05
—
0207026000
—
WV
01
—
27005299700
WORKERS COMP
WV
01
—
270052997004
TRICARE
WV
Enumeration date
06/07/2006
Last updated
12/20/2007
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