| NPI | 1669881249 |
|---|---|
| Former Name | LISA MARIE CLARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: OH COA.16308-NP) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: MI 4704263518) |
| Enumeration Date | 2014-08-07 |
| Last Update Date | 2023-11-03 |