| NPI | 1083094627 |
|---|---|
| Former Name | ELIZABETH ELLEN CLARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL F0315163) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AL 1-136600) |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2023-06-12 |