Provider Demographics
NPI:1952875205
Name:CLARK, DARCY DANIELLE (CPM, LM)
Entity Type:Individual
Prefix:MRS
First Name:DARCY
Middle Name:DANIELLE
Last Name:CLARK
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 W VILLAGE LN
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6217
Mailing Address - Country:US
Mailing Address - Phone:208-850-4590
Mailing Address - Fax:
Practice Address - Street 1:226 W VILLAGE LN
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6217
Practice Address - Country:US
Practice Address - Phone:208-850-4590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMID-89176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife