Individual
OLIVIA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
3909 NEW VISION DR, FORT WAYNE, IN 46845-1725
(260) 469-6602
Mailing address
1234 E DUPONT RD STE 1, FORT WAYNE, IN 46825-1545
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
02/08/2016
Last updated
02/08/2016
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