Individual
NICOLE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10455 LINCOLN HWY, EVERETT, PA 15537-7046
(814) 623-6161
Mailing address
412 BUNKER HILL RD, EVERETT, PA 15537-5539
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
MA061686
PA
363A00000X
Physician Assistant
055-0031682
VT
Other
Enumeration date
07/13/2020
Last updated
07/18/2023
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