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MS. THERESA CARLISLE CLARK REGISTERED NURSE

>> Registered Nurse >> Nursing Service Providers

Registrant NPI Number: 1003056383

Individual Registrant:
MS. THERESA CARLISLE CLARK REGISTERED NURSE
Gender: F
Sole Proprietor

Location and contact information for practice:
1900 CARRIAGE DR  PHENIX CITY, AL 36867-2116 US
Tel: 706-289-9327  Fax: 888-547-2536

Contact information for business:
1900 CARRIAGE DR  PHENIX CITY, AL 36867-2116 US
Tel: 706-289-9327  Fax: 888-547-2536

Registration Information:
NPI: 1003056383
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y163W00000XNursing Service Providers
Registered Nurse
GA166504

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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