Individual
CHRISTOPHER MATTHEW CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
16200 19 MILE RD, CLINTON TOWNSHIP, MI 48038-1103
(586) 873-8607
(586) 416-6705
Mailing address
16200 19 MILE RD, CLINTON TOWNSHIP, MI 48038-1103
(586) 873-8607
(586) 416-6705
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
4704280192
MI
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
4704280192
MI
Other
Enumeration date
10/25/2011
Last updated
11/19/2018
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