Healthcare Provider Details

I. General information

NPI: 1457495723
Provider Name (Legal Business Name): DAVID CLARK ROBARE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209B W WASHINGTON ST
WAUSAU WI
54403-5443
US

IV. Provider business mailing address

H12344 STATE HIGHWAY 52
WAUSAU WI
54403-8933
US

V. Phone/Fax

Practice location:
  • Phone: 715-845-3637
  • Fax: 715-845-1977
Mailing address:
  • Phone: 715-848-8203
  • Fax: 715-842-3821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0088888-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: