| NPI | 1124851639 |
|---|---|
| Former Name | REBECCA SUE CLARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA GAA-NP002544) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 36662) |
| Enumeration Date | 2024-08-21 |
| Last Update Date | 2024-11-25 |