Provider Demographics
NPI:1447841978
Name:CLARK, NANCY
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 NORTH WOODWIND DRIVE
Mailing Address - Street 2:APARTMENT A
Mailing Address - City:ATTICA
Mailing Address - State:OH
Mailing Address - Zip Code:44807
Mailing Address - Country:US
Mailing Address - Phone:419-617-9424
Mailing Address - Fax:
Practice Address - Street 1:207 NORTH WOODWIND DRIVE
Practice Address - Street 2:APARTMENT A
Practice Address - City:ATTICA
Practice Address - State:OH
Practice Address - Zip Code:44807
Practice Address - Country:US
Practice Address - Phone:419-617-9424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care