Individual
MARK BRIAN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
3420 BOX ELDER, EVERGREEN, CO 80439-7841
(303) 674-8431
Mailing address
3420 BOX ELDER, EVERGREEN, CO 80439-7841
(303) 674-8431
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
116712
CO
Other
Enumeration date
08/10/2007
Last updated
08/10/2007
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