Individual
MRS. MICHELLE LYNN CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
260 ELM ST, SUITE 105, SOMERVILLE, MA 02144-2951
(617) 666-9577
(617) 666-3190
Mailing address
260 ELM ST, SUITE 105, SOMERVILLE, MA 02144-2951
(617) 666-9577
(617) 666-3190
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN2275315
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002800301
MEDICARE PTAN
MA
Enumeration date
05/31/2012
Last updated
03/14/2016
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