Individual
ELIZABETH CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
3120 CRISP RD, ENNIS, TX 75119-1479
(972) 268-1001
Mailing address
3120 CRISP RD, ENNIS, TX 75119-1479
(972) 268-1001
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
758228
TX
Other
Enumeration date
05/18/2021
Last updated
05/18/2021
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