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General NPI Number Information
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NPI Number | 1699480202
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Entity Type | Individual
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Provider Name | RACHAEL CLARK
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Gender | Female
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Dates
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Enumeration Date | 01/18/2023
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 7300 N PERIMETER RD
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City | MALMSTROM AFB
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State | MT
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Zip | 59402-6701
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Country | US
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Telephone | 406-731-2110
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Fax |
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Provider Business Mailing Address
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Address Line | 7300 N PERIMETER RD
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City | MALMSTROM AFB
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State | MT
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Zip | 59402-6701
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Country | US
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Telephone | 406-731-2110
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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 | 207866
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License Number State | MT
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