Individual
VENECIA BRIDGETTE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6450 SOUTHCENTER BLVD STE 102, TUKWILA, WA 98188-2552
(206) 721-6170
Mailing address
5455 65TH AVE S, TUKWLIA, WA 98188
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2020092069
TN
363LP2300X
Primary Care Nurse Practitioner
24257
TN
Other
Enumeration date
02/06/2019
Last updated
03/15/2022
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