Provider Demographics
NPI:1730455270
Name:WARE, CLIVE PHILIP (ARNP)
Entity type:Individual
Prefix:MR
First Name:CLIVE
Middle Name:PHILIP
Last Name:WARE
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18390 OSPREY COURT
Mailing Address - Street 2:S/A
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-7725
Mailing Address - Country:US
Mailing Address - Phone:360-420-1728
Mailing Address - Fax:360-416-4977
Practice Address - Street 1:18390 OSPREY COURT
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-7725
Practice Address - Country:US
Practice Address - Phone:360-420-1728
Practice Address - Fax:360-416-4977
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30000184363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily