Individual
MRS. MANDY CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
600 ROE AVE STE 1A, ELMIRA, NY 14905-1676
(607) 737-4130
(607) 737-4530
Mailing address
571 SAINT JOSEPHS BLVD FL 2, ELMIRA, NY 14901-3230
(607) 271-2050
(607) 873-1244
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
0000021347
TN
363L00000X
Nurse Practitioner
Primary
338054
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03802251
—
NY
Enumeration date
09/20/2013
Last updated
09/29/2021
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