Individual
MS. XONNA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CNS, LDN
Contact information
Practice address
9115 ERFURT CT, LAUREL, MD 20708-2870
(704) 516-6973
Mailing address
9115 ERFURT CT, LAUREL, MD 20708-2870
(704) 516-6973
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
Primary
DX3670
MD
Other
Enumeration date
11/15/2014
Last updated
11/15/2014
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