Individual
GAIL A CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
8028 CARNEGIE BLVD STE 300, FORT WAYNE, IN 46804-5788
(260) 425-6650
(260) 755-6233
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
09000192A
IN
367A00000X
Advanced Practice Midwife
71003121A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201044030
—
IN
01
—
815500500
MEDICARE PTAN
IN
Enumeration date
10/19/2009
Last updated
06/04/2024
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