Individual
MAYA NICOLE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD, ACNP-BC
Contact information
Practice address
700 SPRUCE ST, STE. 507, PHILADELPHIA, PA 19106-4022
(215) 829-8455
(215) 829-8431
Mailing address
700 SPRUCE ST, STE. 507, PHILADELPHIA, PA 19106-4022
(215) 829-8455
(215) 829-8431
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
SP009244
PA
Other
Enumeration date
11/16/2006
Last updated
02/09/2015
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