Individual
DANIELLE MICHELLE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3911 AMBROSIA ST STE 201, CASTLE ROCK, CO 80109-3888
(303) 788-8888
(844) 347-5158
Mailing address
3911 AMBROSIA ST STE 201, CASTLE ROCK, CO 80109-3888
(303) 788-8888
(844) 347-5158
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
57187
WV
367500000X
Certified Registered Nurse Anesthetist
Primary
C-APN.0101848-C-CRNA
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1821352485
CIGNA
WV
01
—
270052997002
HEALTHNET/TRICARE
WV
05
—
3810023591
—
WV
01
—
9333201
MEDICARE GROUP
WV
01
—
P01107347
RAILROAD MEDICARE
WV
Enumeration date
06/28/2012
Last updated
05/30/2024
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