Individual
VIRGINIA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2 PARK AVE, DUMONT, NJ 07628-3004
(201) 385-4400
(201) 385-9681
Mailing address
2 PARK AVE, DUMONT, NJ 07628-3004
(201) 385-4400
(201) 385-9681
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
26NR05909800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005908
—
NJ
Enumeration date
07/04/2016
Last updated
07/04/2016
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