Clarke, Angela L

Clarke, Angela L is an individual health care provider with primary practice located at Pima Drive , Fort Hall ID 83203-0306. She recently has only one registered license in Nursing Service Providers / Licensed Practical Nurse, which is considered as her primary health care specialty. Clarke, Angela L can be contacted via phone (208) 238-2400.

Contact Information

Primary practice address
Pima Drive Fort Hall ID 83203-0306
Phone: (208) 238-2400
Fax: (208) 238-5462
Website:
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Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Licensed Practical Nurse 164W00000X PN 10202 Idaho

Profile Details

NPI number 1073768669
LBN Legal business name Clarke, Angela L
Credentials PN
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 24th, 2008
Last updated Nov 24th, 2008 - about 18 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 1073768669 NPPES
Idaho MEDICAID 003399100

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