Clark, Gail A
Clark, Gail A is an sole proprietor health care provider with primary practice located at 8028 Carnegie Blvd Ste 300 , Fort Wayne IN 46804-5788. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife, which is considered as her primary health care specialty. Clark, Gail A can be contacted via phone (260) 425-6650.Contact Information
Primary practice address
8028 Carnegie Blvd Ste 300
Fort Wayne IN 46804-5788
Phone: (260) 425-6650
Fax: (260) 755-6233
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife | 367A00000X | 71003121A | Indiana |
| Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife | 367A00000X | 09000192A | Indiana |
Profile Details
| NPI number | 1760718258 |
|---|---|
| LBN Legal business name | Clark, Gail A |
| Credentials | Certified Nurse Midwife (CNM) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 19th, 2009 |
| Last updated | Jun 4th, 2024 - about 6 months 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1760718258 | NPPES |
| Indiana | MEDICAID | 201044030 | |
| Indiana | Other | 815500500 |
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