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NPI Code Detail

MEDICARE: MRS. VIVIANNE MURIEL CLARK WHNP

MEDICARE: MRS. VIVIANNE MURIEL CLARK WHNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LW0102XWomen's Health Nurse PractitionerNP-291AID
2363LW0102XWomen's Health Nurse PractitionerCNP-01603NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3NPRU3OTHERIDBLUE CROSS
4000010029449OTHERIDBLUE SHIELD

General Provider Information

NPI Number : 1225025489
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. VIVIANNE MURIEL CLARK WHNP
Provider Business Mailing Address
First Line : 7155 E 38TH AVE
Second Line :
City : DENVER
State : CO
Zip : 80207-1630
Country : US
Telephone Number : 303-321-7526
Fax Number : 303-861-0268
Provider Business Practice Location Address
First Line : 7155 E 38TH AVE
Second Line :
City : DENVER
State : CO
Zip : 80207-1630
Country : US
Telephone Number : 303-321-7526
Fax Number : 303-861-0268
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2005
Last Update Date : 11/03/2016

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