Individual
IAN CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
400 COLUMBUS AVE, NEW HAVEN, CT 06519-1233
(203) 503-3000
Mailing address
400 COLUMBUS AVE, NEW HAVEN, CT 06519-1233
(203) 503-3000
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
035458
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004235900
—
CT
Enumeration date
02/03/2011
Last updated
02/03/2011
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