MEDICARE: DONESHA MARQUETTE CLARK

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
1	164W00000X	Licensed Practical Nurse	27405	NE

General Provider Information

NPI Number	:	1295547289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONESHA MARQUETTE CLARK

Provider Business Mailing Address
First Line	:	3357 N 37TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68111-3138
Country	:	US
Telephone Number	:	402-320-8681
Fax Number	:

Provider Business Practice Location Address
First Line	:	3357 N 37TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68111-3138
Country	:	US
Telephone Number	:	402-332-8681
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2025
Last Update Date	:	01/25/2025

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Directions to “ DONESHA MARQUETTE CLARK ” Practice Location

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