Individual
SEPTEMBER CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2701 W MEMORIAL DR, ANTHEM, AZ 85086-4955
(623) 445-7410
Mailing address
4323 W PHALEN DR, NEW RIVER, AZ 85087-5985
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN203512
AZ
Other
Enumeration date
08/17/2017
Last updated
08/17/2017
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