Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 113268 | NE |
NPI | 1023775665 |
---|---|
Provider Name | Nicole Clark |
First Address | Omaha, NE 68198-8102 |
Second Address | Omaha, NE 68198-9510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2021 |
Last Update Date | 18/11/2021 |