Individual
VANESSA CHRISTINA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1135 116TH AVE NE STE 500, BELLEVUE, WA 98004-4627
(425) 635-6560
(425) 637-3210
Mailing address
1135 116TH AVE NE STE 500, BELLEVUE, WA 98004-4627
(425) 635-6560
(425) 637-3210
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.006689
IL
363A00000X
Physician Assistant
61100713
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085.006689
PHYSICIAN ASSISTANT LICENSE
IL
01
—
1151434
NCCPA
—
01
—
61100713
PHYSICIAN ASSISTANT LICENSE
WA
Enumeration date
08/29/2018
Last updated
01/12/2021
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