Individual
KRYSTAL CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6960 ERIE DR, MAINEVILLE, OH 45039-5105
(513) 240-2892
Mailing address
6960 ERIE DR, MAINEVILLE, OH 45039-5105
(513) 240-2892
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
Primary
040877
OH
207U00000X
Nuclear Medicine Physician
560296
OH
Other
Enumeration date
09/22/2017
Last updated
09/22/2017
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