Individual
LEA L CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
717 KNOX COUNTY HIGHWAY 18, YATES CITY, IL 61572
(309) 264-2457
Mailing address
834 N SEMINARY ST, STE 201, GALESBURG, IL 61401-2898
(309) 343-7195
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
209021458
IL
363LF0000X
Family Nurse Practitioner
Primary
209021458
IL
Other
Enumeration date
04/06/2021
Last updated
09/30/2021
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