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Individual

LYREVA J CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RNFNP-C

Contact information

Practice address
6500 HOSPITAL DR, HANNIBAL, MO 63401-6890
(573) 629-3400
Mailing address
PO BOX 551, HANNIBAL, MO 63401-0551
(573) 588-4134
(573) 588-4876

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2003005715
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
429238306
MO
Enumeration date
12/20/2005
Last updated
09/28/2022
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