=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457495723
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID CLARK ROBARE RN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 209B W WASHINGTON ST
-----------------------------------------------------
City | WAUSAU
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54403-5443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-845-3637
-----------------------------------------------------
Fax | 715-845-1977
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | H12344 STATE HIGHWAY 52
-----------------------------------------------------
City | WAUSAU
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54403-8933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-848-8203
-----------------------------------------------------
Fax | 715-842-3821
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 0088888-030
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------