Individual
CRYSTAL DAWN CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
28 B MILLER ROAD, WHEELERSBURG, OH 45694-8103
(740) 285-6493
Mailing address
PO BOX 656, WHEELERSBURG, OH 45694-0656
(740) 285-6493
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
142164
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3146303
—
OH
Enumeration date
12/09/2010
Last updated
10/13/2014
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