Basic Information
| Provider Information | |||||||||
| NPI: | 1720373996 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERNIMAN | ||||||||
| FirstName: | CLARK | ||||||||
| MiddleName: | RENWICK | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O | ||||||||
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| Mailing Information | |||||||||
| Address1: | 158 7TH ST NW | ||||||||
| Address2: | |||||||||
| City: | VALLEY CITY | ||||||||
| State: | ND | ||||||||
| PostalCode: | 580722539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138059265 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2605 CIRCLE DR | ||||||||
| Address2: | |||||||||
| City: | JAMESTOWN | ||||||||
| State: | ND | ||||||||
| PostalCode: | 584016905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012533650 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2011 | ||||||||
| LastUpdateDate: | 12/16/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 13436 | ND | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.