Individual
MS. HEATHER ELAN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
5721 HAMILTON RD, JORDAN, NY 13080-9760
(315) 689-5810
(315) 689-3004
Mailing address
5721 HAMILTON RD, JORDAN, NY 13080-9760
(315) 689-5810
(315) 689-3004
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
661152
NY
Other
Enumeration date
01/23/2020
Last updated
01/23/2020
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