Individual
MRS. CLAUDETTE VIVIENNE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSN,RN,CPNP,IBCLC
Contact information
Practice address
3851 ROGER BROOKE DRIVE, BROOKE ARMY MEDICAL CENTER, FORT SAM HOUSTON, TX 78234-6200
(210) 916-9233
Mailing address
404 DICKMAN RD, SAN ANTONIO, TX 78234-2604
(210) 595-3280
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
1-059903
AL
Other
Enumeration date
01/29/2007
Last updated
07/08/2007
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