Individual
SAMUELA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
6306 N 7TH ST, PHOENIX, AZ 85014-1549
(602) 279-5801
Mailing address
6306 N 7TH ST, PHOENIX, AZ 85014-1549
(602) 279-5801
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
VN192674
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
214634
AHCCCS
AZ
01
—
VN192674
CA LVN LICENSE
CA
Enumeration date
08/27/2007
Last updated
08/27/2007
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