Individual
SHAWNA A CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, FNP
Contact information
Practice address
235 S CANYON BLVD, JOHN DAY, OR 97845-1044
(541) 575-1263
(541) 575-0233
Mailing address
235 S CANYON BLVD, JOHN DAY, OR 97845-1044
(541) 575-1263
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
201150064NP
OR
363LF0000X
Family Nurse Practitioner
NP-1068A
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500640329
—
OR
Enumeration date
06/20/2011
Last updated
10/11/2022
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