Provider Demographics
NPI:1265696272
Name:CLARKE, BARBARA JANET (RN)
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:JANET
Last Name:CLARKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11060 SAN LUIS REY DR
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:CA
Mailing Address - Zip Code:92082-3127
Mailing Address - Country:US
Mailing Address - Phone:760-742-3142
Mailing Address - Fax:
Practice Address - Street 1:11060 SAN LUIS REY DR
Practice Address - Street 2:
Practice Address - City:VALLEY CENTER
Practice Address - State:CA
Practice Address - Zip Code:92082-3127
Practice Address - Country:US
Practice Address - Phone:760-742-3142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA267989163WC0400X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARVN003670OtherMEDICAL
CA015370OtherMEDICAL EPS
CA23310337OtherMEDICAL PIN