Individual
HANNAH GRACE CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD, LDN, PA-C
Contact information
Practice address
110 CHARLOIS BLVD, WINSTON SALEM, NC 27103-1522
(336) 768-3361
(336) 768-4131
Mailing address
110 CHARLOIS BLVD, WINSTON SALEM, NC 27103-1522
(336) 768-3361
(336) 768-4131
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
L003231PL
NC
363A00000X
Physician Assistant
Primary
0010-05131
NC
Other
Enumeration date
02/06/2009
Last updated
07/28/2014
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