Individual
MS. ANN ELIZABETH BLANKENSHIP CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1031 W WILLIAMS ST, APEX, NC 27502-3955
(919) 363-0190
Mailing address
2101 RIDGEFIELD DR, CHAPEL HILL, NC 27517-8661
(704) 293-6312
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
L003116
NC
363A00000X
Physician Assistant
Primary
0010-03932
NC
Other
Enumeration date
12/31/2012
Last updated
12/31/2012
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