Theresa Carlisle Clark REGISTERED NURSE

NPI 1003056383 - Registered Nurse - 163W00000X

NPI Details
NPI 1003056383
Gender Female
Enumeration Date 02/26/2009
Last Updated 02/26/2009
Entity Type Individual
Active Over 7 years ago
Practice Location
1900 CARRIAGE DR
PHENIX CITY AL, 36867-2116, US
Phone (706) 289-9327
Fax (888) 547-2536
Business Location
1900 CARRIAGE DR
PHENIX CITY AL, 36867-2116, US
Phone (706) 289-9327
Fax (888) 547-2536
Toxanomy
Taxonomy Code 163W00000X
License State Georgia
License Number 166504
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According to our database, Ms. Theresa Carlisle Clark REGISTERED NURSE NPI is 1003056383, taxonomy code is 163W00000X and license number is 166504, license state is located at Georgia. Theresa Carlisle Clark REGISTERED NURSE physically located at 1900 Carriage Dr, Phenix City AL, 36867-2116. NPI Number Theresa Carlisle Clark REGISTERED NURSE has the Individual type.

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1003056383 NPI number is provided on an as is basis without warranty of any kind. 1003056383 is maintained by the National Plan & Provider Enumeration System. The contents of Theresa Carlisle Clark REGISTERED NURSE are for informational purposes only.