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MRS. TERRI LEE CLARK RN

>> Registered Nurse >> Nursing Service Providers

Registrant NPI Number: 1942372966

Individual Registrant:
MRS. TERRI LEE CLARK RN
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

Contact information for business:
1505 N RYNDERS ST  GRAND CHUTE, WI 54914-1614 US
Tel: 920-993-8445  Fax: 920-993-8445

Registration Information:
NPI: 1942372966
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
X163W00000XNursing Service Providers
Registered Nurse
WI
X163WH0200XNursing Service Providers
Registered Nurse
WI

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
38276400WI05




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