Provider Demographics
NPI:1093140097
Name:CLARKE, EWA T (HC)
Entity Type:Individual
Prefix:
First Name:EWA
Middle Name:T
Last Name:CLARKE
Suffix:
Gender:F
Credentials:HC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 N CUERNAVACA DR APT J
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78733-3244
Mailing Address - Country:US
Mailing Address - Phone:512-731-3875
Mailing Address - Fax:
Practice Address - Street 1:307 N CUERNAVACA DR APT J
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78733-3244
Practice Address - Country:US
Practice Address - Phone:512-731-3875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-09
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator