Individual
CRYSTAL CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
650 HIGHLAND AVE # 100, WINSTON SALEM, NC 27101-4304
(336) 607-8523
Mailing address
284 EXECUTIVE PARK DR STE 100, CONCORD, NC 28025-1833
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
091485
NC
Other
Enumeration date
06/01/2021
Last updated
06/01/2021
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