Individual
STEPHEN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTITIONER
Contact information
Practice address
1013 E HAINES ST, PHILADELPHIA, PA 19138-1533
(215) 438-1095
Mailing address
1013 E HAINES ST, PHILADELPHIA, PA 19138-1533
(215) 438-1095
Taxonomy
Speciality
Code
Description
License number
State
364SF0001X
Family Health Clinical Nurse Specialist
Primary
SP013599
PA
Other
Enumeration date
02/27/2014
Last updated
02/27/2014
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