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1366090573
DONALD LEE CLARK
GRANITE CITY, IL
NPI
1366090573
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: IL 209019719)
Enumeration Date
2019-08-30
Last Update Date
2019-08-30
Business Address
DONALD LEE CLARK FNP-BC
2100 MADISON AVE
GRANITE CITY, IL 62040-4713
Phone number: 618-798-3000
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Mailing Address
DONALD LEE CLARK FNP-BC
8308 BURLINGTON DR
TROY, IL 62294-4003
Phone number: 618-402-3946
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