Healthcare Provider Details

I. General information

NPI: 1508781089
Provider Name (Legal Business Name): GINGER CLARK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 HWY. 49 NORTH
MARIPOSA CA
95338-9503
US

IV. Provider business mailing address

5300 HWY 49 N P.O. BOX 5
MARIPOSA CA
95338-0005
US

V. Phone/Fax

Practice location:
  • Phone: 209-617-8748
  • Fax:
Mailing address:
  • Phone: 209-617-8748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number804948
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: