Clark, Donna M

Clark, Donna M is an individual health care provider with primary practice located at 130 Cedar Rd Ste 200 , Vista CA 92083-5102. She recently has 4 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse, Nursing Service Providers / Diabetes Educator, Nursing Service Providers / Gerontology, Physician Assistants & Advanced Practice Nursing Providers / Gerontology. Physician Assistants & Advanced Practice Nursing Providers / Gerontology is her primary health care specialty. Clark, Donna M can be contacted via phone (760) 806-5620.

Contact Information

Primary practice address
130 Cedar Rd Ste 200 Vista CA 92083-5102
Phone: (760) 806-5620
Fax: (760) 806-5639
Website:
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Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X RN485608 California
Nursing Service Providers / Diabetes Educator 163WD0400X RN485608 California
Nursing Service Providers / Gerontology 163WG0600X RN485608 California
Physician Assistants & Advanced Practice Nursing Providers / Gerontology 363LG0600X 6328 California

Profile Details

NPI number 1104832617
LBN Legal business name Clark, Donna M
Credentials Gerontological Nurse Practitioner (GNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 1st, 2006
Last updated Aug 2nd, 2013 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1104832617 NPPES
California MEDICAID RN485608

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