Individual
MEREDITH RENAE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
605 COTTON ST, WINSTON SALEM, NC 27101-5080
(336) 716-2255
Mailing address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
3999-33
WI
363L00000X
Nurse Practitioner
Primary
5010316
NC
363LG0600X
Gerontology Nurse Practitioner
3999
WI
Other
Enumeration date
03/11/2010
Last updated
04/05/2018
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