BENJAMIN JACOB CLARK

ELKHART, IN
NPI1407150055
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy367500000X Nurse Anesthetist, Certified Registered
(Licence: IN  28193318A)
Enumeration Date2010-12-22
Last Update Date2010-12-22
Business Address
-- BENJAMIN JACOB CLARK CRNA
600 EAST BLVD
ELKHART, IN 46514-2483
Phone number: 574-523-3193
Mailing Address
-- BENJAMIN JACOB CLARK CRNA
14660 CARRIGAN CT
GRANGER, IN 46530-4222
Phone number: 574-523-3193
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