Provider Demographics
NPI:1821516600
Name:CLARK, ANDREW LOUIS
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:LOUIS
Last Name:CLARK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 E WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-4056
Mailing Address - Country:US
Mailing Address - Phone:775-686-0117
Mailing Address - Fax:
Practice Address - Street 1:777 E WILLIAM ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89701-4056
Practice Address - Country:US
Practice Address - Phone:775-686-0117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician