Individual
CRYSTAL CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
153 BRAMBURY DR APT D, ROCHESTER, NY 14621-1820
(404) 621-2852
Mailing address
PO BOX 64283, ROCHESTER, NY 14624-6683
(404) 321-2852
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
—
—
372600000X
Adult Companion
Primary
—
—
376K00000X
Nurse's Aide
NYGA0401903R
NY
Other
Enumeration date
07/06/2019
Last updated
07/06/2019
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