Provider Demographics
NPI:1063286029
Name:SHIM, CLARA (BSN, RN-BC, CCRN)
Entity type:Individual
Prefix:
First Name:CLARA
Middle Name:
Last Name:SHIM
Suffix:
Gender:F
Credentials:BSN, RN-BC, CCRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SURREY LN
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-3344
Mailing Address - Country:US
Mailing Address - Phone:678-860-3153
Mailing Address - Fax:
Practice Address - Street 1:19 SURREY LN
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-3344
Practice Address - Country:US
Practice Address - Phone:678-860-3153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2258476163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine