| NPI | 1801435052 |
|---|---|
| Former Name | REBECCA ELIZABETH CLARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 53-78887-112) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care |
| Enumeration Date | 2020-01-04 |
| Last Update Date | 2020-01-22 |