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Individual

HEATHER CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
3200 E RACINE ST, JANESVILLE, WI 53546-2343
(608) 371-8000
(608) 371-8939
Mailing address
3200 E RACINE ST, JANESVILLE, WI 53546-2343
(608) 371-8000
(608) 371-8939

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4092-23
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1467976696
WI
Enumeration date
07/31/2017
Last updated
11/05/2020
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