Individual
JUDITH CR CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
32605 W 12 MILE RD STE 195, FARMINGTON HILLS, MI 48334-3390
(313) 306-2023
Mailing address
3621 S STATE ST, 700 KMS PLACE, ANN ARBOR, MI 48108
(734) 936-2047
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704171391
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4643072
—
MI
01
—
5008707110
BCBSM
MI
01
—
P00365326
MEDICARE-RAILROAD
MI
Enumeration date
07/11/2005
Last updated
06/20/2022
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