Individual
JANELL LANICE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
1738 W CHELTENHAM AVE, PHILADELPHIA, PA 19126-1546
(215) 548-3390
(215) 549-8998
Mailing address
1738 W CHELTENHAM AVE, PHILADELPHIA, PA 19126-1546
(215) 548-3390
(215) 549-8998
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
SP010694
PA
363LA2200X
Adult Health Nurse Practitioner
Primary
SP010694
PA
Other
Enumeration date
04/23/2010
Last updated
10/13/2020
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