Individual
LISA ANN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2215 FULLER RD, ANN ARBOR, MI 48105-2303
(734) 925-6687
Mailing address
2215 FULLER RD, ANN ARBOR, MI 48105-2303
(734) 925-6687
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
4704918286
MI
Other
Enumeration date
10/05/2022
Last updated
10/05/2022
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