Individual
MRS. JACQUELYN IRENE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
48696 BENWOOD RD, SARDIS, OH 43946-9638
(740) 483-2249
Mailing address
48696 BENWOOD RD, SARDIS, OH 43946-9638
(740) 483-2249
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
12185
WV
164W00000X
Licensed Practical Nurse
Primary
PN091690
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2564130
—
OH
Enumeration date
01/16/2007
Last updated
07/08/2007
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