Provider Demographics
NPI:1649573593
Name:CLARKE, LINDA VERONICA (ND)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:VERONICA
Last Name:CLARKE
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1183 NW RIVERFRONT DR
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-6168
Mailing Address - Country:US
Mailing Address - Phone:541-315-8394
Mailing Address - Fax:
Practice Address - Street 1:1183 NW RIVERFRONT DR
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-6168
Practice Address - Country:US
Practice Address - Phone:541-580-5599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-15
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR171100000X
OR1147175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist