Individual
AMANDA LOUISE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, BSN
Contact information
Practice address
1871 SAVAGE RD, CHARLESTON, SC 29407-4726
(843) 766-6308
Mailing address
PO BOX 23321, NEW YORK, NY 10087-4321
(614) 632-4049
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
246707
SC
363LP0200X
Pediatric Nurse Practitioner
Primary
26661
SC
Other
Enumeration date
03/28/2020
Last updated
11/01/2024
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