Individual
NICOLETTE MW CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
128 E APPLE ST, DAYTON, OH 45409-2902
(937) 208-4953
Mailing address
128 E APPLE ST, DAYTON, OH 45409-2902
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
57.251172
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
57.251172
TRAINING CERTIFICATE (MD)
OH
Enumeration date
04/20/2021
Last updated
02/18/2026
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