Individual
CLARK CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APNP
Contact information
Practice address
1820 CENTER AVE STE 170, JANESVILLE, WI 53546-2878
(608) 755-1475
(608) 755-1733
Mailing address
203 W SUNNY LN, JANESVILLE, WI 53546-9091
(608) 755-1475
(608) 755-1733
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
7914
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1962773648
—
WI
Enumeration date
01/26/2012
Last updated
03/01/2021
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