Individual
MRS. DEBRA ANN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2044 MADISON AVE, SUITE G7, GRANITE CITY, IL 62040-4641
(618) 451-6685
(618) 451-7292
Mailing address
2044 MADISON AVE, SUITE G7, GRANITE CITY, IL 62040-4641
(618) 451-6685
(618) 451-7292
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
Primary
—
IL
Other
Enumeration date
05/08/2007
Last updated
07/08/2007
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