Individual
LYDIA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3610 E 300 N, FREMONT, IN 46737-9785
(419) 348-3129
Mailing address
3610 E 300 N, FREMONT, IN 46737-9785
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0185693
—
OH
Enumeration date
01/25/2019
Last updated
01/25/2019
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