Individual
GAIL MARIE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2073 OLYMPIC ST, SPRINGFIELD, OR 97477-3413
(541) 228-4200
Mailing address
2073 OLYMPIC ST, SPRINGFIELD, OR 97477-3413
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
201401771LPN
OR
Other
Enumeration date
04/17/2014
Last updated
04/17/2014
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