Clark, Jenna Marie

Clark, Jenna Marie is an sole proprietor health care provider with primary practice located at 1 Childrens Plz , Dayton OH 45404-1815. She recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Lactation Consultant, Physician Assistants & Advanced Practice Nursing Providers / Neonatal. Physician Assistants & Advanced Practice Nursing Providers / Neonatal is her primary health care specialty. Clark, Jenna Marie can be contacted via phone (937) 641-5072.

Contact Information

Primary practice address
1 Childrens Plz Dayton OH 45404-1815
Phone: (937) 641-5072
Fax: (937) 641-6129
Website:
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Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Lactation Consultant 163WL0100X RN 343251 L-88563 Ohio
Physician Assistants & Advanced Practice Nursing Providers / Neonatal 363LN0000X APRN.CNP.0030509 Ohio

Profile Details

NPI number 1144687492
LBN Legal business name Clark, Jenna Marie
Credentials NNP
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jan 18th, 2016
Last updated May 13th, 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1144687492 NPPES
Ohio MEDICAID 0015277

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