Individual
MS. SUSAN MARIE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.R.N.P.
Contact information
Practice address
301 RANDOLPH ST, DENTON, MD 21629-1243
(410) 479-4306
(410) 479-1714
Mailing address
301 RANDOLPH ST, DENTON, MD 21629-1243
(410) 479-4306
(410) 479-1714
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R157798
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
207884
PRIORITY PARTNERS
—
01
—
521116591
MARYLAND PHYSICIANS CARE
MD
01
—
766408
NCPPO
—
05
—
784381000
—
MD
01
—
89583301
CAREFIRST BC/BS RENDERING
MD
01
—
9924498
CIGNA
—
01
—
T5880040
CF BC/BS GRP/GHMSI/BL CHO
MD
Enumeration date
08/01/2006
Last updated
06/30/2008
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