Provider Demographics
NPI:1730309998
Name:CLARK, LAPRIEL
Entity Type:Individual
Prefix:
First Name:LAPRIEL
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 E 1300 N
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2570
Mailing Address - Country:US
Mailing Address - Phone:435-792-6500
Mailing Address - Fax:435-792-6600
Practice Address - Street 1:655 E 1300 N
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2570
Practice Address - Country:US
Practice Address - Phone:435-792-6500
Practice Address - Fax:435-792-6600
Is Sole Proprietor?:No
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT195293-4405 A.P.R.N.363LC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health