| NPI | 1679301402 |
|---|---|
| Former Name | BRISTOL WYNNE CLARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: MO 2024031044) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: KS 53-83405-092) |
| Enumeration Date | 2024-07-23 |
| Last Update Date | 2024-08-05 |