Individual
MICHAEL ERIC CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.N.
Contact information
Practice address
75 BANTING DR, GEORGETOWN, OH 45121-1460
(937) 378-4811
(937) 378-4812
Mailing address
75 BANTING DR, GEORGETOWN, OH 45121-1460
(937) 378-4811
(937) 378-4812
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
RN 300536
OH
Other
Enumeration date
04/26/2012
Last updated
04/26/2012
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