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General NPI Number Information
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NPI Number | 1851629422
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Entity Type | Individual
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Provider Name | DENNIS ERIN CLARK
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Gender | Male
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Dates
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Enumeration Date | 11/19/2009
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Last Update Date | 11/19/2009
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Provider Practice Location Address
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Address Line | 112 W MCDONALD ST
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City | EDGERTON
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State | KS
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Zip | 66021-2430
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Country | US
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Telephone | 913-882-9704
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Fax |
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Provider Business Mailing Address
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Address Line | 112 W MCDONALD ST
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City | EDGERTON
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State | KS
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Zip | 66021-2430
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Country | US
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Telephone |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 13-86682-081
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 2009001167
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License Number State | MO
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