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Individual

PORTIA CLARK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1316 N TIBBS AVE, INDIANAPOLIS, IN 46222-3024
(317) 634-8330
Mailing address
1316 N TIBBS AVE, INDIANAPOLIS, IN 46222-3024
(317) 634-8330

Taxonomy

Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary

Other

Enumeration date
10/20/2022
Last updated
10/20/2022
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