Individual
MRS. DIANE K CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP
Contact information
Practice address
9427 SW BARNES RD, STE 595, PORTLAND, OR 97225-6640
(503) 216-1150
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
(503) 215-6644
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
201150003NP
OR
363LA2100X
Acute Care Nurse Practitioner
Primary
201150003NP
OR
363LA2100X
Acute Care Nurse Practitioner
278877-4405
UT
364SC0200X
Critical Care Medicine Clinical Nurse Specialist
278877-4405
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500631611
—
OR
01
—
P00957594
RR MEDICARE
OR
Enumeration date
02/27/2008
Last updated
02/19/2021
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