Donna M Clark, GNP
Nurse Practitioner, Gerontology in Vista, CA. Individual provider (NPI-1).
NPI number1104832617
StatusActive
Last updated in NPPESAug 2, 2013
Details
- NPI
- 1104832617
- Entity type
- Individual (NPI-1)
- Name
- Donna M Clark
- Credential
- GNP
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Aug 1, 2006
- Last updated
- Aug 2, 2013
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LG0600X | Nurse Practitioner, Gerontology | 6328 | CA | Yes |
| 163W00000X | Registered Nurse | RN485608 | CA | |
| 163WD0400X | Registered Nurse, Diabetes Educator | RN485608 | CA | |
| 163WG0600X | Registered Nurse, Gerontology | RN485608 | CA |
Practice location
130 Cedar Rd Ste 200Vista, CA 92083-5102
Phone 760-806-5620 · Fax 760-806-5639
Mailing address
10170 Sorrento Valley RdSan Diego, CA 92121-1604
Phone 858-784-5888
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