Individual
NATISHA IRENE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6777 W MAPLE RD, WEST BLOOMFIELD, MI 48322-3013
(800) 683-6568
(313) 876-1305
Mailing address
1 FORD PL STE 3A, DETROIT, MI 48202-3450
(313) 874-4806
(313) 876-1305
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704278418
MI
363LP2300X
Primary Care Nurse Practitioner
Primary
4704278418
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1871957985
BLUE CROSS BLUE SHEILD
MI
05
—
1871957985
—
MI
Enumeration date
04/06/2016
Last updated
11/10/2022
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