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Individual
STACEY ELLEN CLARK
Active
Individual
STACEY ELLEN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
NP14812
CA
363LF0000X
Family Nurse Practitioner
Primary
5005457
NC
Other
Enumeration date
07/03/2006
Last updated
11/13/2014
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