Individual
ANNIE H CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(508) 334-3550
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN2320602
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110180815A
—
MA
05
—
3136797
—
NH
Enumeration date
02/27/2020
Last updated
02/19/2025
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