Individual
LAURA E CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
930 N 14TH ST, NEW CASTLE, IN 47362-4311
(765) 521-2450
Mailing address
240 N TILLOTSON AVE, MUNCIE, IN 47304-3988
(765) 288-1928
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71003386A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201002830
—
IN
01
—
945350168
MEDICARE
—
Enumeration date
11/16/2010
Last updated
11/14/2019
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