Individual
MRS. TAMARA DELAVIGNE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, RN, CPNP-AC
Contact information
Practice address
700 CHILDRENS DR, COLUMBUS, OH 43205-2664
(614) 722-2000
Mailing address
835 E PARKWOOD ST, SIDNEY, OH 45365-1976
(937) 497-8222
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
RN274268
OH
363LP0222X
Critical Care Pediatric Nurse Practitioner
Primary
NP-09601
OH
Other
Enumeration date
10/09/2007
Last updated
10/09/2007
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