| NPI | 1821539495 |
|---|---|
| Former Name | TALISA SOMWANG CLARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5009380) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: NC 5009380) |
| Enumeration Date | 2017-03-16 |
| Last Update Date | 2023-02-20 |