Provider Demographics
NPI:1689291932
Name:CLARKE UNIVERSITY
Entity Type:Organization
Organization Name:CLARKE UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR OF HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:563-588-6374
Mailing Address - Street 1:1550 CLARKE DR # 1722
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-3117
Mailing Address - Country:US
Mailing Address - Phone:563-588-6374
Mailing Address - Fax:
Practice Address - Street 1:1550 CLARKE DR # 1722
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-3117
Practice Address - Country:US
Practice Address - Phone:563-588-6374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-02
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health