Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | AP30002563 | WA |
N | 363LX0001X | Nurse Practitioner - Obstetrics & Gynecology | AP30002563 | WA |
NPI | 1023024940 |
---|---|
Provider Name | Lynn A Clark |
First Address | Tacoma, WA 98405-5300 |
Second Address | Tacoma, WA 98405-5300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 02/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0191324 | STATE L&I (01) | WA |
0191325 | STATE L&I (01) | WA |
0207828 | STATE L&I (01) | WA |
1042540 | (05) | WA |
8939401 | STATE CRIME VICTIMS (01) | WA |
8939483 | STATE CRIME VICTIMS (01) | WA |
9607680 | (05) | WA |
P00354459 | MEDICARE RAILROAD (01) | WA |
S48229 | (02) | WA |