Individual
JESSICA NICOLE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
1825 LOGAN AVE, WATERLOO, IA 50703-1916
(319) 235-3697
Mailing address
924 BERTCH AVE, WATERLOO, IA 50702-3110
(319) 939-2404
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
A154270
IA
Other
Enumeration date
09/19/2019
Last updated
09/19/2019
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