Individual
ANGELA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3555 KNICKERBOCKER RD, SAN ANGELO, TX 76904-7610
(325) 949-9555
Mailing address
3555 KNICKERBOCKER RD, SAN ANGELO, TX 76904-7610
(325) 949-9555
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP130678
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
360901801
—
TX
Enumeration date
03/18/2014
Last updated
12/08/2021
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