Individual
ANITA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1203 US HIGHWAY 98, SUITE 2A, DAPHNE, AL 36526-4277
(251) 621-9167
Mailing address
2868 ACTON RD, BIRMINGHAM, AL 35243-2502
(205) 968-8360
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
1-020410
AL
Other
Enumeration date
06/22/2009
Last updated
06/22/2009
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