Provider Demographics
NPI:1073852257
Name:CLARK, DANNY F (CNALPN)
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:F
Last Name:CLARK
Suffix:
Gender:M
Credentials:CNALPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6237 OVERTURE DR
Mailing Address - Street 2:
Mailing Address - City:WEST CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-3340
Mailing Address - Country:US
Mailing Address - Phone:937-414-7537
Mailing Address - Fax:
Practice Address - Street 1:6237 OVERTURE DR
Practice Address - Street 2:
Practice Address - City:WEST CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:45449-3340
Practice Address - Country:US
Practice Address - Phone:937-414-7537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide