Individual
MRS. CHRISTINE A CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
11 EVELYN CT, MANORVILLE, NY 11949-2851
(631) 801-3188
Mailing address
11 EVELYN CT, MANORVILLE, NY 11949-2851
(631) 801-3188
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
180733
NY
Other
Enumeration date
10/19/2012
Last updated
10/19/2012
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