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General NPI Number Information
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NPI Number | 1144043910
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Entity Type | Individual
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Provider Name | JENNA MARIE CLARK MSN FNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/31/2024
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 1201 S CARSON ST
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City | CARSON CITY
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State | NV
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Zip | 89701-5225
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Country | US
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Telephone | 775-445-7330
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Fax | 775-841-1139
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Provider Business Mailing Address
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Address Line | 1157 WESTHAVEN AVE
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City | CARSON CITY
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State | NV
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Zip | 89703-2368
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Country | US
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Telephone | 774-445-9099
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 884347
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License Number State | NV
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