Clark, Judith Cr

Clark, Judith Cr is an individual health care provider with primary practice located at 32605 W 12 Mile Rd Ste 195 , Farmington Hills MI 48334-3390. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Clark, Judith Cr can be contacted via phone (313) 306-2023.

Contact Information

Primary practice address
32605 W 12 Mile Rd Ste 195 Farmington Hills MI 48334-3390
Phone: (313) 306-2023
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 4704171391 Michigan

Profile Details

NPI number 1780682138
LBN Legal business name Clark, Judith Cr
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 11th, 2005
Last updated Jun 20th, 2022 - about 2 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 1780682138 NPPES
Michigan Other P00365326 MEDICARE-RAILROAD
Michigan Other 5008707110 MEDICARE-RAILROAD
Michigan MEDICAID 4643072 MEDICARE-RAILROAD

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