Individual
DOTTIE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
907 EDGERTON DR, JOLIET, IL 60435-0409
(815) 905-8808
Mailing address
907 EDGERTON DR, JOLIET, IL 60435-0409
(815) 905-8808
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
043.072241
IL
Other
Enumeration date
09/14/2016
Last updated
09/14/2016
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