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Contact Information

DIANE K CLARK, ACNP
9427 SW BARNES RD
STE 595
PORTLAND, OR97225-6640
 Phone: 503-216-1150
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Acute Care

363LA2100X 50 Nurse Practitioner
 

Critical Care Medicine

364SC0200X 89 Certified Clinical Nurse Specialist
 

Nurse Practitioner

363L00000X 50 Nurse Practitioner
Indicates primary specialty

NPI Profile & details for DIANE K CLARK · (Female)

NPI # 1881863488
Status Active
Credentials ACNP
Entity Individual
Enumeration date 02/27/2008
Last updated 02/19/2021 - About 5 years ago
Sole proprietor 1 No
Identifiers
  • OR License # 201150003NP
  • UT License # 278877-4405
  • OR Medicaid 500631611
  • OR Other P00957594 RR MEDICARE
Hospital affiliation(s)
  • PROVIDENCE ST VINCENT MEDICAL CENTER - (Acute Care)
    9205 SW BARNES ROAD
    PORTLAND, OR 97225
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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