Individual
SHARDAE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4127 STONE POST RD, NEWPORT, MI 48166-7830
(313) 247-9493
Mailing address
4127 STONE POST RD, NEWPORT, MI 48166-7830
(313) 247-9493
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4708311201
MI
Other
Enumeration date
09/03/2015
Last updated
09/03/2015
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