Individual
MISS SHEA RANDI CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1000 BLYTHE BLVD, CHARLOTTE, NC 28203-5812
(704) 355-2000
Mailing address
704 VALLEYVIEW DR, ALBEMARLE, NC 28001-9592
(704) 438-0893
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
270821
NC
367500000X
Certified Registered Nurse Anesthetist
Primary
138248
NC
Other
Enumeration date
07/13/2021
Last updated
02/14/2022
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