Healthcare Provider Details

I. General information

NPI: 1316369655
Provider Name (Legal Business Name): NORINE CLARK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2014
Last Update Date: 01/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 S VALLEY VIEW BLVD
LAS VEGAS NV
89107-4361
US

IV. Provider business mailing address

330 S VALLEY VIEW BLVD
LAS VEGAS NV
89107-4361
US

V. Phone/Fax

Practice location:
  • Phone: 702-759-0850
  • Fax:
Mailing address:
  • Phone: 702-759-0850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN25324
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License NumberRN25324
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: