Individual
DR. KRISTIN L. CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1821 S WEBSTER AVE, GREEN BAY, WI 54301-2253
(920) 496-4700
Mailing address
5485 W GRANDE MARKET DR STE C, APPLETON, WI 54913-8430
(920) 729-7105
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
46761-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34577900
—
WI
Enumeration date
06/16/2005
Last updated
11/26/2019
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