Individual
STEPHANIE NICOLE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2700 WAYNE MEMORIAL DR, GOLDSBORO, NC 27534-9494
(919) 731-6068
(919) 731-6025
Mailing address
105 KATHERINE DR, STE G, FLOWOOD, MS 39232-8857
(919) 731-6068
(919) 731-6025
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
111055
AL
367500000X
Certified Registered Nurse Anesthetist
Primary
901448
MS
Other
Enumeration date
09/29/2016
Last updated
10/02/2018
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