Individual
NICOLE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
332 WILSON DR, BLOOMFIELD, IN 47424-1054
(317) 432-3861
Mailing address
332 WILSON DR, BLOOMFIELD, IN 47424-1054
(317) 432-3861
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36001806A
IN
Other
Enumeration date
12/03/2015
Last updated
12/03/2015
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