Individual
MR. JOHN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
52 N TU SU LN, BISHOP, CA 93514-8058
(760) 873-8461
(760) 873-3530
Mailing address
RR 2 BOX 24R, BISHOP, CA 93514-9610
(760) 387-2187
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
RN629103
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1659433191
ORGANIZATION NPI #
CA
Enumeration date
01/23/2007
Last updated
07/08/2007
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