Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 95001169 | CA |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | NP95001169 | CA |
NPI | 1427450386 |
---|---|
Provider Name | Heather Anne Clark |
First Address | Stanford, CA 94305-2200 |
Second Address | Stanford, CA 94305-2200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2014 |
Last Update Date | 07/10/2015 |