| NPI | 1184269417 |
|---|---|
| Former Name | MELISSA ISALENE CLARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: AL 1-156218) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-156218) |
| Enumeration Date | 2019-11-11 |
| Last Update Date | 2022-10-19 |