Individual
JESSICA CLARK-GOMEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
342 E UNION ST, RICHLAND CENTER, WI 53581-2217
(608) 647-6415
Mailing address
342 E UNION ST, RICHLAND CENTER, WI 53581-2217
(608) 647-6415
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35030800
—
WI
Enumeration date
09/04/2007
Last updated
09/04/2007
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