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General NPI Number Information
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NPI Number | 1720373996
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Entity Type | Individual
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Provider Name | CLARK RENWICK HERNIMAN D.O
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Gender | Male
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Dates
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Enumeration Date | 06/15/2011
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Last Update Date | 12/16/2021
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Provider Practice Location Address
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Address Line | 2605 CIRCLE DR
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City | JAMESTOWN
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State | ND
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Zip | 58401-6905
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Country | US
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Telephone | 701-253-3650
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Fax |
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Provider Business Mailing Address
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Address Line | 158 7TH ST NW
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City | VALLEY CITY
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State | ND
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Zip | 58072-2539
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Country | US
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Telephone | 713-805-9265
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 13436
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License Number State | ND
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