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General NPI Number Information
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NPI Number | 1295540375
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Entity Type | Individual
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Provider Name | NICHOLAS CLARK
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Gender | Male
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Dates
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Enumeration Date | 02/07/2025
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 2610 W M CT
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City | LINCOLN
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State | NE
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Zip | 68522-1006
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Country | US
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Telephone | 402-325-8555
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Fax |
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Provider Business Mailing Address
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Address Line | 525 NORTH ST
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City | HALLAM
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State | NE
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Zip | 68368-2009
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Country | US
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Telephone | 402-617-1252
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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 | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State |
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