Individual
MS. MONIQUE R CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
20755 GREENFIELD RD, SUITE 100, SOUTHFIELD, MI 48075-5403
(248) 557-0507
Mailing address
26520 MEADOWOOD CT N, LATHRUP VILLAGE, MI 48076-4650
(313) 595-2218
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4704262087
MI
Other
Enumeration date
12/13/2016
Last updated
12/13/2016
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