Glenda Clark

Key facts

NPI

1356883458

Entity type

Individual (NPI type 1)

Primary specialty

Licensed Vocational Nurse 164X00000X

License

VN119113 (CA)

Practice address

7005 County Road 27
Orland, CA 95963-9782

Phone

(530) 520-8894

NPI assigned

Nov 7, 2016

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Nov 7, 2016.

{
    "created_epoch": "1478476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478476800000",
    "number": "1356883458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7005 COUNTY ROAD 27",
            "city": "ORLAND",
            "state": "CA",
            "postal_code": "959639782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7005 COUNTY ROAD 27",
            "city": "ORLAND",
            "state": "CA",
            "postal_code": "959639782",
            "telephone_number": "530-520-8894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "GLENDA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-11-07",
        "last_updated": "2016-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "VN119113",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Orland, CA · Licensed Vocational Nurse in California