| NPI | 1043766074 |
|---|---|
| Former Name | STEPHANIE NICOLE CLARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP131671) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 737860) |
| Enumeration Date | 2016-08-30 |
| Last Update Date | 2020-04-15 |