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General NPI Number Information
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NPI Number | 1023315231
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Entity Type | Individual
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Provider Name | JENNIFER ALEXANDRIA CLARK
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Gender | Female
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Dates
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Enumeration Date | 02/24/2011
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Last Update Date | 01/11/2022
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Provider Practice Location Address
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Address Line | 99 MONTECILLO RD
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City | SAN RAFAEL
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State | CA
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Zip | 94903-3308
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Country | US
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Telephone | 925-229-7693
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Fax |
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Provider Business Mailing Address
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Address Line | 20 BARNESON AVE #C
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City | SAN MATEO
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State | CA
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Zip | 94402-2978
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Country | US
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Telephone | 310-266-2796
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 086522
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License Number State | CA
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