Provider Demographics
NPI:1225601164
Name:JENATTE CLARK DERMATOLOGY PLLC
Entity type:Organization
Organization Name:JENATTE CLARK DERMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JENATTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:509-945-7777
Mailing Address - Street 1:4209 TIETON DR STE 102
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-3377
Mailing Address - Country:US
Mailing Address - Phone:509-945-7777
Mailing Address - Fax:509-966-8812
Practice Address - Street 1:4209 TIETON DR STE 102
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-3377
Practice Address - Country:US
Practice Address - Phone:509-945-7777
Practice Address - Fax:509-966-8812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty