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Individual
WANDA LU CLARK
Active
Individual
WANDA LU CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
509539
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
142123201
—
TX
01
—
85N188
BCBS TX
TX
Enumeration date
07/19/2005
Last updated
03/24/2020
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