Individual
MR. MICHAEL CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
593 EDDY ST, APC SUITE 523, PROVIDENCE, RI 02903-4923
(401) 444-8467
Mailing address
593 EDDY ST, APC SUITE 523, PROVIDENCE, RI 02903-4923
(401) 444-8467
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APRN01380
RI
363LC0200X
Critical Care Medicine Nurse Practitioner
APRN01380
RI
Other
Enumeration date
07/18/2016
Last updated
11/24/2020
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