Individual
KELLY PATRICIA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
55 PINE DR E, MASON, MI 48854-9229
(517) 394-6484
Mailing address
55 PINE DR E, MASON, MI 48854-9229
(517) 394-6484
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703110786
MI
Other
Enumeration date
02/22/2019
Last updated
02/22/2019
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