Individual
SAMUEL CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AGACNP
Contact information
Practice address
4755 OGLETOWN STANTON RD STE 2E99, NEWARK, DE 19718-2200
(302) 733-5982
(302) 733-6081
Mailing address
3566 MAIN ST, FREDERICA, DE 19946-1265
(302) 632-7359
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
L1-0048020
DE
363LA2100X
Acute Care Nurse Practitioner
Primary
LP-0010513
DE
363LG0600X
Gerontology Nurse Practitioner
LP-0010513
DE
Other
Enumeration date
05/20/2024
Last updated
07/12/2024
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