Individual
WILLIETTE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9311 WILLOW CREEK DR, APT F, MONTGOMERY VILLAGE, MD 20886-0422
(240) 751-5779
Mailing address
9311 WILLOW CREEK DR, APT F, MONTGOMERY VILLAGE, MD 20886-0422
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
1003182
DC
Other
Enumeration date
03/08/2016
Last updated
03/08/2016
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