Individual
CATHERINE J CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
111 PORT WATSON ST, CORTLAND, NY 13045-3157
(607) 753-9326
(607) 756-8458
Mailing address
111 PORT WATSON ST, CORTLAND, NY 13045-3157
(607) 753-9326
(607) 756-8458
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
260610-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
260610-1
NYS LPN LICENSE
NY
Enumeration date
07/08/2011
Last updated
07/08/2011
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