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Individual

SARAH J CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APNP

Contact information

Practice address
10400 75TH ST, KENOSHA, WI 53142
(262) 948-7000
(414) 385-4436
Mailing address
10400 75TH ST, KENOSHA, WI 53142-7884
(262) 948-7000
(414) 385-4436

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4201
WI
363LA2200X
Adult Health Nurse Practitioner
4201
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100012080
WI
Enumeration date
10/05/2010
Last updated
10/09/2023
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