Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 195293-4405 A.P.R.N. | UT |
NPI | 1730309998 |
---|---|
Provider Name | Lapriel Clark |
First Address | Logan, UT 84341-2570 |
Second Address | Logan, UT 84341-2570 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2007 |
Last Update Date | 08/07/2007 |