Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | OP00002070 | WA |
NPI | 1144291360 |
---|---|
Provider Name | Dr. Nathaniel Wise Clark |
First Address | Seattle, WA 98112-5226 |
Second Address | Seattle, WA 98112-5226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2006 |
Last Update Date | 31/03/2021 |