Individual
SHANA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
25900 GREENFIELD RD STE 414, OAK PARK, MI 48237-1267
(248) 242-1193
Mailing address
23745 ROCKINGHAM ST, SOUTHFIELD, MI 48033-7025
(248) 242-1193
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
4704307625
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8848947
—
MI
Enumeration date
08/17/2020
Last updated
08/17/2020
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