| NPI | 1093377905 |
|---|---|
| Former Name | NICHOLE CLARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 10067) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209019549) |
| Enumeration Date | 2019-07-01 |
| Last Update Date | 2026-05-11 |