Individual
NICOLE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
N4093 KEEHN RD, WINTER, WI 54896-7312
(989) 709-1937
Mailing address
N4093 KEEHN RD, WINTER, WI 54896-7312
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
233138
WI
163W00000X
Registered Nurse
4704325266
MI
Other
Enumeration date
09/20/2017
Last updated
03/17/2018
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