Individual
KELLY SUE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
28 CHICK ST, METROPOLIS, IL 62960-2467
(618) 524-2176
Mailing address
320 LINDSEY AVE, METROPOLIS, IL 62960-1162
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
041405442
IL
Other
Enumeration date
04/27/2018
Last updated
04/27/2018
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