Provider Demographics
NPI:1215475389
Name:CLARKE, ANDREA (RDMS(OB/GYN)(ABD))
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:CLARKE
Suffix:
Gender:F
Credentials:RDMS(OB/GYN)(ABD)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 W 200 S
Mailing Address - Street 2:202
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84101-1213
Mailing Address - Country:US
Mailing Address - Phone:801-703-4419
Mailing Address - Fax:
Practice Address - Street 1:328 W 200 S
Practice Address - Street 2:202
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-1213
Practice Address - Country:US
Practice Address - Phone:801-703-4419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography