Provider Demographics
NPI:1033799069
Name:CLARK, BARBARA JOAN (RN61149827)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:JOAN
Last Name:CLARK
Suffix:
Gender:F
Credentials:RN61149827
Other - Prefix:MRS
Other - First Name:BARBARA
Other - Middle Name:JOAN
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN61149827
Mailing Address - Street 1:7440 W MARGINAL WAY S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-4141
Mailing Address - Country:US
Mailing Address - Phone:206-768-1990
Mailing Address - Fax:
Practice Address - Street 1:1960 THOMPSON DR
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-5007
Practice Address - Country:US
Practice Address - Phone:360-856-3186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61149824163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty