| Doctor Name: | LARAINE CLARK |
| NPI Number: | 1154717882 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN, IBCLC |
| License Number: | 000042163RN |
| Business Practice Address: | 31460 Sw Isle Way Ln West Linn, OR - 970689408 |
| Business Phone Number: | 5034546917 |
| Business Fax Number: | |
| Mailing Address: | 31460 Sw Isle Way Ln, WEST LINN |
| State: | OR |
| Postal Code: | 970689408 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 04/09/2015 |
| NPI Last Update Date: | 04/09/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WL0100X |
| License Number: | 000042163RN |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Lactation Consultant |
| Taxonomy Definition: | |