Individual
KIM MICHELE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
6820 NW GRANDVIEW DR, CORVALLIS, OR 97330-2706
(541) 753-0708
Mailing address
6820 NW GRANDVIEW DR, CORVALLIS, OR 97330-2706
(541) 753-0708
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
095006090RN
OR
172V00000X
Community Health Worker
—
—
Other
Enumeration date
08/15/2008
Last updated
08/15/2008
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