Individual
CHARLENE M CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
27 HEYWARD ST, BRENTWOOD, NY 11717-1909
(631) 273-1439
Mailing address
27 HEYWARD ST, BRENTWOOD, NY 11717-1909
(631) 273-1439
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
289760
NY
Other
Enumeration date
07/31/2013
Last updated
07/31/2013
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