Individual
ANDREA NICOLE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
9869 STATE ROUTE 141, KITTS HILL, OH 45645-8649
(740) 532-4806
Mailing address
9869 STATE ROUTE 141, KITTS HILL, OH 45645-8649
(740) 532-4806
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
141456
OH
164W00000X
Licensed Practical Nurse
31330
WV
Other
Enumeration date
09/22/2010
Last updated
10/28/2014
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