Provider Demographics
NPI:1346329976
Name:CLARK, JANICE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-4532
Mailing Address - Country:US
Mailing Address - Phone:563-241-4000
Mailing Address - Fax:563-241-4004
Practice Address - Street 1:507 S 4TH ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-4532
Practice Address - Country:US
Practice Address - Phone:563-241-4000
Practice Address - Fax:563-241-4004
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAF065159363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAP16363Medicare UPIN
IAI12204Medicare ID - Type Unspecified