Individual
MRS. JACQUELINE RUTH CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
26308 CROCKER RD, COLUMBIA STATION, OH 44028-9301
(440) 374-6063
Mailing address
26308 CROCKER RD, COLUMBIA STATION, OH 44028-9301
(440) 374-6063
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN. 107698
OH
Other
Enumeration date
10/13/2008
Last updated
10/13/2008
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