Individual
TWYLA K CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1821 S STOUGHTON RD, MADISON, WI 53716-2257
(608) 260-6000
(608) 260-6366
Mailing address
1821 S STOUGHTON RD, MADISON, WI 53716-2257
(608) 260-6000
(608) 260-6366
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3366-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1457760563
—
WI
Enumeration date
08/04/2014
Last updated
11/05/2020
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