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General NPI Number Information
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NPI Number | 1952359911
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Entity Type | Individual
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Provider Name | JOANN MARIE CLARK NP
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Gender | Female
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 200 WEST ARBOR DRIVE MC 8201 UCSD MEDICAL CENTER
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City | SAN DIEGO
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State | CA
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Zip | 92103-8201
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Country | US
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Telephone | 858-657-8531
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Fax | 619-543-3183
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Provider Business Mailing Address
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Address Line | 10430 BRIARCLIFF WAY
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City | SAN DIEGO
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State | CA
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Zip | 92131-1334
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Country | US
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Telephone | 858-271-9809
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | NP7801
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License Number State | CA
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