Individual
STEPHANIE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
7920 OLD CEDAR AVE S, BLOOMINGTON, MN 55425-1207
(952) 428-1800
(952) 428-1723
Mailing address
1125 E 17TH ST STE W248, SANTA ANA, CA 92701-2205
(714) 547-5151
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
14465
MN
363A00000X
Physician Assistant
52997
CA
Other
Enumeration date
12/16/2015
Last updated
12/05/2025
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