Provider Demographics
NPI:1326073487
Name:CLARK, KARA G (CRNA)
Entity Type:Individual
Prefix:MS
First Name:KARA
Middle Name:G
Last Name:CLARK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1912 PALMGREN DR
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-4216
Mailing Address - Country:US
Mailing Address - Phone:847-729-9086
Mailing Address - Fax:847-729-9086
Practice Address - Street 1:1912 PALMGREN DR
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-4216
Practice Address - Country:US
Practice Address - Phone:847-729-9086
Practice Address - Fax:847-729-9086
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered