Individual provider · NPI-1

Desa Mariah Clark, APRN

Nurse Practitioner, Family · Fremont, NE

NPI number1215519814
StatusActive
Last updated in NPPESJul 7, 2021

Details

NPI
1215519814
Entity type
Individual (NPI-1)
Name
Desa Mariah Clark
Credential
APRN
Sex
Female
Sole proprietor
No
Enumeration date
Apr 22, 2021
Certification date
Jul 7, 2021
Last updated
Jul 7, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363LF0000X Nurse Practitioner, Family113657NEYes
163W00000X Registered Nurse64709NE

Other names

  • Desa Mariah Eldridge (Former Name)

Practice location

2560 N Healthy Way
Fremont, NE 68025-2315

Phone 402-941-7245

Mailing address

605 E Thomsen St
Fremont, NE 68025-9235

Phone 402-317-0797

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