| Doctor Name: | SHAWNA A CLARK |
| NPI Number: | 1962798793 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DNP, FNP |
| License Number: | NP-1068A |
| Business Practice Address: | 180 Ford Rd John Day, OR - 978452009 |
| Business Phone Number: | 5415750404 |
| Business Fax Number: | |
| Mailing Address: | 180 Ford Rd, JOHN DAY |
| State: | OR |
| Postal Code: | 978452009 |
| Phone Number: | 5415750404 |
| Fax Number: | |
| NPI Enumeration Date: | 06/20/2011 |
| NPI Last Update Date: | 06/13/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | NP-1068A |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | ID |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |