Clark, Marlene L

Clark, Marlene L is an individual health care provider with primary practice located at 1025 N Country Club Dr , Mesa AZ 85201-3307. She recently has only one registered license in Nursing Service Providers / School, which is considered as her primary health care specialty. Clark, Marlene L can be contacted via phone (480) 472-0502.

Contact Information

Primary practice address
1025 N Country Club Dr Mesa AZ 85201-3307
Phone: (480) 472-0502
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / School 163WS0200X RN092499 Arizona

Profile Details

NPI number 1720293897
LBN Legal business name Clark, Marlene L
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date May 11th, 2007
Last updated Jul 9th, 2007 - about 17 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 1720293897 NPPES
Arizona MEDICAID 623810

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