Individual
TAMMIE DIANE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
9324 TAYLOR ST E, EDGEWOOD, WA 98371-1249
(770) 910-2743
Mailing address
9324 TAYLOR ST E, EDGEWOOD, WA 98371-1249
(770) 910-2743
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP00049051
WA
Other
Enumeration date
06/02/2025
Last updated
06/02/2025
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