Individual
BRIAN K CLARK SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
15201 JUDSON DR, CLEVELAND, OH 44128-1956
(216) 855-1969
Mailing address
15201 JUDSON DR, CLEVELAND, OH 44128-1956
(216) 855-1969
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
169548
OH
Other
Enumeration date
05/31/2019
Last updated
05/31/2019
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