Individual
KRYSTA ELLEN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
364 MAINE ST, POLAND, ME 04274-5109
(207) 312-8987
Mailing address
364 MAINE ST, POLAND, ME 04274-5109
(207) 312-8987
Taxonomy
Speciality
Code
Description
License number
State
163WD0400X
Diabetes Educator Registered Nurse
Primary
RN74374
ME
Other
Enumeration date
05/28/2025
Last updated
05/28/2025
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