Individual
DEBRA LYNN ANN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
116 SECOND ST, GREENLAND, MI 49929
(906) 883-3539
Mailing address
506 S STEEL ST, ONTONAGON, MI 49953-1554
(906) 884-4430
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
4703059261
MI
Other
Enumeration date
05/07/2010
Last updated
05/07/2010
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