Individual
NICHOLAS CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
9040 JACKSON AVE, TACOMA, WA 98431-9098
(253) 968-1110
Mailing address
9040 JACKSON AVE, TACOMA, WA 98431-0001
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0102207074
VA
Other
Enumeration date
03/20/2020
Last updated
05/07/2025
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