Individual
AVA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1680 WALDEN AVE, CHEEKTOWAGA, NY 14225-4914
(716) 894-7777
(716) 894-0604
Mailing address
93 LARCHMONT RD, BUFFALO, NY 14214-1209
(716) 898-4266
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
593066
NY
Other
Enumeration date
09/25/2012
Last updated
09/25/2012
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