Individual
MEGAN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
224 N EAST ST, LEBANON, IN 46052-2224
(765) 894-7982
Mailing address
224 N EAST ST, LEBANON, IN 46052-2224
(765) 894-7982
Taxonomy
Speciality
Code
Description
License number
State
347C00000X
Private Vehicle
Primary
0340308057
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
105626973999
—
IN
05
—
105626974799
—
IN
Enumeration date
11/07/2016
Last updated
11/07/2016
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