Individual
MICHELLE RUTH CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
144 STATE ST, PORTLAND, ME 04101-3776
(207) 899-5322
Mailing address
77 DANFORTH ST APT 2, PORTLAND, ME 04101-3588
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PAN1716
ME
Other
Enumeration date
07/30/2017
Last updated
07/30/2017
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