Provider Demographics
NPI:1720841422
Name:CLARK, HOLLY BETH (CD(DONA))
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:BETH
Last Name:CLARK
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7478 SANTA YSABEL AVE UNIT G
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-4667
Mailing Address - Country:US
Mailing Address - Phone:805-610-6626
Mailing Address - Fax:
Practice Address - Street 1:7478 SANTA YSABEL AVE UNIT G
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-4667
Practice Address - Country:US
Practice Address - Phone:805-610-6626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula