DONNA M CLARK GNP NPI 1104832617

NPI Information

  • NPI: 1104832617
  • Provider Name: DONNA M CLARK, GNP
  • Classification: Nurse Practitioner - 363LG0600X
  • Specialization: Gerontology
  • Entity Type: Individual
  • Address: 130 CEDAR RD STE 200
    VISTA, CA
    ZIP 92083
  • Phone: (760) 806-5620

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NPI Details

Donna M Clark, GNP is a gerontology nurse practitioner in Vista, CA. Donna M Clark, GNP NPI is 1104832617. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

130 CEDAR RD STE 200
VISTA, CA
ZIP 92083-102
Phone: (760) 806-5620
Fax: (760) 806-5639

The enumeration date for this NPI number is 8/1/2006 and was last updated on 8/2/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1163W00000XRegistered NurseRN485608CALIFORNIANo
2163WD0400XRegistered NurseDiabetes EducatorRN485608CALIFORNIANo
3163WG0600XRegistered NurseGerontologyRN485608CALIFORNIANo
4363LG0600XNurse PractitionerGerontology6328CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1WNP6328AMEDICARE ID-TYPE UNSPECIFIEDCALIFORNIA
2RN485608MEDICAIDCALIFORNIA
3P09312MEDICARE UPINCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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