Individual
COLLETTE ANDREA CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
34 LILLIE LN, STATEN ISLAND, NY 10314-6358
(347) 585-3598
(347) 442-3100
Mailing address
34 LILLIE LN, STATEN ISLAND, NY 10314-6358
(347) 585-3598
(347) 442-3100
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
657617
NY
163WH0200X
Home Health Registered Nurse
657617
NY
171W00000X
Contractor
657617
NY
207Q00000X
Family Medicine Physician
657617
NY
Other
Enumeration date
09/04/2012
Last updated
09/04/2012
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