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Individual
NATISHA IRENE CLARK
Active
Individual
NATISHA IRENE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704278418
MI
363LP2300X
Primary Care Nurse Practitioner
Primary
4704278418
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1871957985
BLUE CROSS BLUE SHEILD
MI
05
—
1871957985
—
MI
Enumeration date
04/06/2016
Last updated
11/10/2022
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