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Individual
JUDITH CR CLARK
Active
Individual
JUDITH CR CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704171391
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4643072
—
MI
01
—
5008707110
BCBSM
MI
01
—
P00365326
MEDICARE-RAILROAD
MI
Enumeration date
07/11/2005
Last updated
06/20/2022
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