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Individual
RENITA CLARK
Active
Individual
RENITA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
3085432
OH
164W00000X
Licensed Practical Nurse
Primary
PN126160
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3085432
—
OH
Enumeration date
08/28/2008
Last updated
06/22/2011
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