| NPI | 1750942892 |
|---|---|
| Former Name | JOHANNA THERESA CLARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IA A154199) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IA a154199) |
| Enumeration Date | 2019-06-27 |
| Last Update Date | 2024-10-29 |