Individual
MYRA LESLIE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD, NP-C
Contact information
Practice address
7048 MECHANICSVILLE TPKE, MECHANICSVILLE, VA 23111-7101
(804) 730-9498
(804) 569-7967
Mailing address
2485 RANSON CT, CHARLOTTESVILLE, VA 22911-8622
(434) 293-0660
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024170893
VA
Other
Enumeration date
09/23/2008
Last updated
10/11/2013
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