Provider Demographics
NPI:1457495723
Name:ROBARE, DAVID CLARK (RN)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:CLARK
Last Name:ROBARE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:H12344 STATE HIGHWAY 52
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-8933
Mailing Address - Country:US
Mailing Address - Phone:715-848-8203
Mailing Address - Fax:715-842-3821
Practice Address - Street 1:209B W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-5443
Practice Address - Country:US
Practice Address - Phone:715-845-3637
Practice Address - Fax:715-845-1977
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0088888-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse