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1881842938
KELLY C. CLARK
MILWAUKEE, WI
NPI
1881842938
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Former Name
KELLY C. COBURN
Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363L00000X Nurse Practitioner
(Licence: WI 3480)
Enumeration Date
2008-09-03
Last Update Date
2008-09-03
Business Address
Ms. KELLY C. CLARK APNP
9000 W WISCONSIN AVE
MILWAUKEE, WI 53226-4874
Phone number: 414-805-3666
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Mailing Address
Ms. KELLY C. CLARK APNP
10000 W INNOVATION DR THIRD FLOOR
MILWAUKEE, WI 53226-4837
Phone number: 414-456-5006
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