Clark, Natisha Irene

Clark, Natisha Irene is an sole proprietor health care provider with primary practice located at 6777 W Maple Rd , West Bloomfield MI 48322-3013. She recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse, Physician Assistants & Advanced Practice Nursing Providers / Primary Care. Physician Assistants & Advanced Practice Nursing Providers / Primary Care is her primary health care specialty. Clark, Natisha Irene can be contacted via phone (800) 683-6568.

Contact Information

Primary practice address
6777 W Maple Rd West Bloomfield MI 48322-3013
Phone: (800) 683-6568
Fax: (313) 876-1305
Website:
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Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X 4704278418 Michigan
Physician Assistants & Advanced Practice Nursing Providers / Primary Care 363LP2300X 4704278418 Michigan

Profile Details

NPI number 1871957985
LBN Legal business name Clark, Natisha Irene
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 6th, 2016
Last updated Nov 10th, 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 1871957985 NPPES
Michigan MEDICAID 1871957985
Michigan Other 1871957985

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