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General NPI Number Information
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NPI Number | 1760785240
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Entity Type | Individual
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Provider Name | STEVEN WESTON-CLARK LPN
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Gender | Male
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Dates
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Enumeration Date | 12/06/2010
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Last Update Date | 12/06/2023
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Provider Practice Location Address
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Address Line | 830 SABALU RD
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City | FORT LEAVENWORTH
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State | KS
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Zip | 66027-2315
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Country | US
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Telephone | 139-758-3989
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Fax |
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Provider Business Mailing Address
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Address Line | 216 7TH ST LOT 9
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City | FERRELVIEW
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State | MO
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Zip | 64163-1418
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Country | US
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Telephone | 319-360-7944
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 2009003462
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License Number State | MO
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