Individual
SAMANTHA FENNELLA CLARKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15 ISABELLA AVE APT 3R, BAYONNE, NJ 07002-4373
(347) 357-3666
Mailing address
15 ISABELLA AVE APT. 3R, BAYONNE, NJ 07002
(347) 357-3666
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
248896
NY
Other
Enumeration date
07/13/2015
Last updated
07/13/2015
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