| NPI | 1922951987 |
|---|---|
| Former Name | LUETRICIA SHAWNICE CLARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 00010173) |
| Enumeration Date | 2026-02-18 |
| Last Update Date | 2026-02-22 |