Most Relevant Information
Provider Data
| NPI Number: | 1003056383 |
| Provider Name: | THERESA CARLISLE CLARK REGISTERED NURSE |
| Entity Type: | Individual |
| Taxonomy Code: | 163W00000X |
| Specialty: | Registered Nurse |
| License Number: | 166504 |
Most Important Dates
| Enumeration Date: | 02/26/2009 |
| Last Updated: | 02/26/2009 |
Provider Practice Location
1900 CARRIAGE DR
PHENIX CITY
AL
368672116
Practice Location Phone/Fax
| Phone: | 7062899327 |
| Fax: | 8885472536 |
Provider Mailing Location
1900 CARRIAGE DR
PHENIX CITY
AL
368672116
Provider Mailing Phone/Fax
| Phone: | 7062899327 |
| Fax: | 8885472536 |