Individual
MARY CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
229 ELMHURST RD, DAYTON, OH 45417-1420
(740) 637-7456
Mailing address
229 ELMHURST RD, DAYTON, OH 45417-1420
(740) 637-7456
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
—
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2334183
—
OH
Enumeration date
03/10/2020
Last updated
03/10/2020
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