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1538196563
NICOLE LORRAINE CLARK
BOISE, ID
NPI
1538196563
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: ID AT-208)
Enumeration Date
2006-06-26
Last Update Date
2007-07-08
Business Address
Ms. NICOLE LORRAINE CLARK LAT, ATC
1010 W WASHINGTON ST
BOISE, ID 83702-5446
Phone number: 208-854-4270
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Mailing Address
Ms. NICOLE LORRAINE CLARK LAT, ATC
6472 W PARAPET DR
BOISE, ID 83714-8849
Phone number: 208-377-3597
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