Individual
MICAH SHEA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
990 OAK RIDGE TPKE, OAK RIDGE, TN 37830-6976
(931) 858-6303
(931) 858-6305
Mailing address
PO BOX 5059, OAK RIDGE, TN 37831-5059
(770) 237-1089
(770) 237-1124
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
075331
TN
Other
Enumeration date
11/28/2006
Last updated
07/08/2007
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