Individual
DENNIS WAYNE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1757 IMPERIAL BLVD., LAKE CHARLES, LA 70605
(337) 310-2832
Mailing address
13523 BARRETT PARKWAY DRIVE, SUITE 104, BALLWIN, MO 63021-3802
(636) 936-6868
(636) 938-1486
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1-097193
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03429236
—
MS
05
—
051511198
—
AL
01
—
51511198
BCBS
AL
Enumeration date
06/27/2006
Last updated
08/16/2010
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