Active NPI
Jeanne Patrice Clark, REGISTERED NURSE
- Registered Nurse
- Plain, WI
National Provider Identifier
1750609665
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 82329-30
- Practice address
- S 9466 Valley View Rd
Plain, WI 53577 - Phone
- (608) 546-9212
- NPI assigned
- May 17, 2010
- Last updated
- May 17, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 82329-30 | WI | Primary |
Addresses
Primary practice location
S 9466 Valley View Rd
Plain, WI 53577
Mailing address
S 9466 Valley View Rd
Plain, WI 53577
Phone (608) 546-9212
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 82329-30 | WI | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1274054400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1274054400000",
"number": "1750609665",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "S 9466 VALLEY VIEW RD",
"city": "PLAIN",
"state": "WI",
"postal_code": "53577",
"telephone_number": "608-546-9212"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "S 9466 VALLEY VIEW RD",
"city": "PLAIN",
"state": "WI",
"postal_code": "53577",
"telephone_number": "608-546-9212"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "JEANNE",
"middle_name": "PATRICE",
"name_prefix": "Ms.",
"credential": "REGISTERED NURSE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-05-17",
"last_updated": "2010-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "WI",
"license": "82329-30",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plain, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.