| NPI | 1952897001 |
|---|---|
| Former Name | DIANA M CLARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.017817) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209017817) |
| Enumeration Date | 2018-07-02 |
| Last Update Date | 2024-08-07 |