Individual
ANN MARIE CLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
WHNP
Contact information
Practice address
4864 JACKSON ST, MONROE, LA 71202-6400
(318) 330-7000
Mailing address
1512 W KIRBY PL, SHREVEPORT, LA 71103-3822
(318) 626-0287
Taxonomy
Speciality
Code
Description
License number
State
163WM0102X
Maternal Newborn Registered Nurse
RN122544
LA
363LW0102X
Women's Health Nurse Practitioner
Primary
214452
LA
Other
Enumeration date
07/07/2021
Last updated
10/06/2021
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