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MRS. TERRI LEE CLARK RN
>> Registered Nurse >> Nursing Service ProvidersRegistrant NPI Number: 1942372966
Individual Registrant:MRS. TERRI LEE CLARK RN
Gender: F
Sole Proprietor
Gender: F
Sole Proprietor
Location and contact information for practice:
1505 N RYNDERS ST GRAND CHUTE, WI 54914-1614 US
Tel: 920-993-8445 Fax: 920-993-8445
Tel: 920-993-8445 Fax: 920-993-8445
Contact information for business:
1505 N RYNDERS ST GRAND CHUTE, WI 54914-1614 US
Tel: 920-993-8445 Fax: 920-993-8445
Tel: 920-993-8445 Fax: 920-993-8445
Registration Information:
NPI: 1942372966
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| X | 163W00000X | Nursing Service Providers Registered Nurse | WI | |
| X | 163WH0200X | Nursing Service Providers Registered Nurse | WI |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| 38276400 | WI | 05 |
