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General NPI Number Information
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NPI Number | 1528486172
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Entity Type | Individual
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Provider Name | RHONDA IDDINS CLARK FNP
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Gender | Female
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Dates
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Enumeration Date | 04/01/2014
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Last Update Date | 04/27/2021
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Provider Practice Location Address
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Address Line | 1402 BAILEY AVE
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City | NEEDLES
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State | CA
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Zip | 92363-3104
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Country | US
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Telephone | 760-326-0222
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Fax | 760-326-0221
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Provider Business Mailing Address
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Address Line | 1402 BAILEY AVE
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City | NEEDLES
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State | CA
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Zip | 92363-3104
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Country | US
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Telephone | 760-326-0222
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Fax | 760-326-0221
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 18691
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3009621
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 240243
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95006850
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License Number State | CA
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