Individual
LONNIE W. CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
16420 W US HIGHWAY 24, WOODLAND PARK, CO 80863-8760
(806) 790-3928
Mailing address
420 PAISLEY DR, COLORADO SPRINGS, CO 80906-8205
(806) 790-3928
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
690859
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
147825100
—
TX
01
—
147825101
FIRSTCARE COMMERCIAL
TX
05
—
179419001
—
TX
05
—
200073510A
—
OK
01
—
202004266
PRESBYTERIAN COMMERCIAL
NM
05
—
202004266
—
NM
05
—
64851729
—
NM
05
—
67349
—
TX
01
—
86091U
HMO BLUE
TX
01
—
86092U
BC/BS
TX
05
—
90739868
—
CO
Enumeration date
08/12/2006
Last updated
12/09/2020
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