Individual
DIANE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, BSN
Contact information
Practice address
1118 F ST, LEWISTON, ID 83501-1930
(208) 799-4440
(208) 799-5171
Mailing address
1118 F ST, LEWISTON, ID 83501-1930
(208) 799-4440
(208) 799-5171
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
N-29174
ID
Other
Enumeration date
03/24/2016
Last updated
03/24/2016
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