Individual
MARY ANN CLARK
Active
Individual
MARY ANN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
1-125268
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-125268
ALABAMA BOARN OF NURSING LICENSE NUMBER
AL
Enumeration date
03/29/2017
Last updated
03/29/2017
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