Provider Demographics
NPI:1760785240
Name:WESTON-CLARK, STEVEN (LPN)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:WESTON-CLARK
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 7TH ST
Mailing Address - Street 2:LOT 9
Mailing Address - City:FERRELVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64163-1418
Mailing Address - Country:US
Mailing Address - Phone:319-360-7944
Mailing Address - Fax:
Practice Address - Street 1:830 SABALU RD
Practice Address - Street 2:
Practice Address - City:FORT LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66027-2315
Practice Address - Country:US
Practice Address - Phone:139-758-3989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009003462164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse