Provider Demographics
NPI:1386534493
Name:CLARK, RACHAL DIANE (RN, SANE-A)
Entity type:Individual
Prefix:
First Name:RACHAL
Middle Name:DIANE
Last Name:CLARK
Suffix:
Gender:F
Credentials:RN, SANE-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10793 ROUTE 414
Mailing Address - Street 2:
Mailing Address - City:ROARING BRANCH
Mailing Address - State:PA
Mailing Address - Zip Code:17765-9007
Mailing Address - Country:US
Mailing Address - Phone:570-418-1204
Mailing Address - Fax:
Practice Address - Street 1:700 HIGH ST
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701
Practice Address - Country:US
Practice Address - Phone:570-321-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN734063163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse