Daniel Ewing Clark, CRNA
Nurse Anesthetist, Certified Registered in Idaho Falls, ID. Individual provider (NPI-1).
NPI number1295267029
StatusActive
Last updated in NPPESFeb 3, 2023
Details
- NPI
- 1295267029
- Entity type
- Individual (NPI-1)
- Name
- Daniel Ewing Clark
- Credential
- CRNA
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Mar 30, 2017
- Certification date
- Feb 3, 2023
- Last updated
- Feb 3, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | 54479 | ID | Yes |
Practice location
3100 Channing WayIdaho Falls, ID 83404-7533
Phone 208-529-6111
Mailing address
3100 Channing WayIdaho Falls, ID 83404-7533
Phone 208-529-6111
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