Individual
SUEANNE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
6025 BLAKENEY PARK DR, STE 100, CHARLOTTE, NC 28277-5703
(704) 667-4480
Mailing address
PO BOX 19305, CHARLOTTE, NC 28219-9305
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
5004696
NC
Other
Enumeration date
09/11/2008
Last updated
12/20/2019
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