Individual
STEPHANIE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1951 BENCH ROAD, STE A, POCATELLO, ID 83201-2073
(208) 549-7385
(208) 216-6761
Mailing address
1951 BENCH ROAD, STE A, POCATELLO, ID 83201-2073
(208) 549-7385
(208) 216-6761
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
N-35468
ID
363L00000X
Nurse Practitioner
Primary
NP-1100A
ID
Other
Enumeration date
09/08/2011
Last updated
09/21/2023
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