Individual
WENDY S CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
1234 E. DUPONT RD., SUITE 6, FORT WAYNE, IN 46825-1545
(260) 480-2600
(260) 496-8077
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71001332A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200365810
—
IN
01
—
500024448
MEDICARE RR
IN
Enumeration date
11/04/2005
Last updated
10/15/2022
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