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Individual
TERESA LOUISE CLARK
Active
Individual
TERESA LOUISE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LVN
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
258115
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
164W
LICENSED VOCATIONAL NURSE
CA
Enumeration date
04/05/2013
Last updated
04/23/2013
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