Most Relevant Information
Provider Data
| NPI Number: | 1003223090 |
| Provider Name: | ERIKA CLARK |
| Entity Type: | Individual |
| Taxonomy Code: | 164W00000X |
| Specialty: | Licensed Practical Nurse |
| License Number: | 4703104793 |
Most Important Dates
| Enumeration Date: | 07/22/2014 |
| Last Updated: | 07/22/2014 |
Provider Practice Location
350 ELM ST
DIMONDALE
MI
488219556
Practice Location Phone/Fax
| Phone: | 5174102004 |
| Fax: |
Provider Mailing Location
PO BOX 76
DIMONDALE
MI
488210076
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |