Individual
MINNIE R CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
200 OHIO ST, MEDINA, NY 14103-1063
(585) 798-2000
Mailing address
1642 BLOOD RD, LYNDONVILLE, NY 14098-9606
(585) 590-6431
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
310179
NY
Other
Enumeration date
02/22/2021
Last updated
02/22/2021
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