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General NPI Number Information
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NPI Number | 1033020029
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Entity Type | Individual
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Provider Name | EMILY CLARK
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Gender | Female
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Dates
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Enumeration Date | 09/16/2026
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Last Update Date | 09/16/2026
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Provider Practice Location Address
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Address Line | 2222 N NEVADA AVE
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-6819
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Country | US
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Telephone | 719-776-7127
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Fax |
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Provider Business Mailing Address
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Address Line | 6350 OAKWOOD BLVD
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City | COLORADO SPRINGS
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State | CO
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Zip | 80923-5172
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Country | US
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Telephone | 719-776-7127
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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 | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number | 1641352
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License Number State | CO
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