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Individual
GAIL A CLARK
Active
Individual
GAIL A CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNM
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
09000192A
IN
367A00000X
Advanced Practice Midwife
71003121A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201044030
—
IN
01
—
815500500
MEDICARE PTAN
IN
Enumeration date
10/19/2009
Last updated
06/04/2024
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