Provider Demographics
NPI:1831464650
Name:CLARE, RD (FNP)
Entity Type:Individual
Prefix:
First Name:RD
Middle Name:
Last Name:CLARE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1272 O RD
Mailing Address - Street 2:
Mailing Address - City:LOMA
Mailing Address - State:CO
Mailing Address - Zip Code:81524-9543
Mailing Address - Country:US
Mailing Address - Phone:970-640-9850
Mailing Address - Fax:
Practice Address - Street 1:2754 COMPASS DR
Practice Address - Street 2:STE 170
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-8714
Practice Address - Country:US
Practice Address - Phone:970-254-1686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-12
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO90097363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily