Provider Demographics
NPI:1992356901
Name:CLARK, SARAH RUTH
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:RUTH
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 1:1181 WOODWORTH RD
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98930-9769
Mailing Address - Country:US
Mailing Address - Phone:509-830-1989
Mailing Address - Fax:
Practice Address - Street 1:1181 WOODWORTH RD
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:WA
Practice Address - Zip Code:98930-9769
Practice Address - Country:US
Practice Address - Phone:509-830-1989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider