Carroll, Clark

Carroll, Clark is an individual health care provider with primary practice located at 1820 Center Ave Ste 170 , Janesville WI 53546-2878. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, which is considered as his primary health care specialty. Carroll, Clark can be contacted via phone (608) 755-1475.

Contact Information

Primary practice address
1820 Center Ave Ste 170 Janesville WI 53546-2878
Phone: (608) 755-1475
Fax: (608) 755-1733
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 7914 Wisconsin

Profile Details

NPI number 1962773648
LBN Legal business name Carroll, Clark
Credentials APNP
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 26th, 2012
Last updated Mar 1st, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1962773648 NPPES
Wisconsin MEDICAID 1962773648

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