Individual
BRENDA LOU CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
332 N TRADE ST, STE 1100, MATTHEWS, NC 28105-1728
(704) 512-6850
Mailing address
PO BOX 19305, CHARLOTTE, NC 28219-9305
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
5009311
NC
363LF0000X
Family Nurse Practitioner
Primary
5009311
NC
Other
Enumeration date
10/05/2005
Last updated
07/15/2024
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