Provider Demographics
NPI:1508208307
Name:CLARK, EVELYN BARDAGO (MSN, ANP, NP-C)
Entity Type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:BARDAGO
Last Name:CLARK
Suffix:
Gender:F
Credentials:MSN, ANP, NP-C
Other - Prefix:MS
Other - First Name:EVELYN
Other - Middle Name:BARDAGO
Other - Last Name:HU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP-C
Mailing Address - Street 1:1011 39TH AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-2504
Mailing Address - Country:US
Mailing Address - Phone:970-351-8181
Mailing Address - Fax:
Practice Address - Street 1:1011 39TH AVE
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-2504
Practice Address - Country:US
Practice Address - Phone:970-351-8181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0990763363LF0000X
CA23234363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily