Most Relevant Information
Provider Data
| NPI Number: | 1003434069 |
| Provider Name: | CAROLYN TERESA CLARK RN BSN |
| Entity Type: | Individual |
| Taxonomy Code: | 163W00000X |
| Specialty: | Registered Nurse |
| License Number: | RN308661L |
Most Important Dates
| Enumeration Date: | 07/07/2020 |
| Last Updated: | 07/07/2020 |
Provider Practice Location
1155 E MOUNTAIN BLVD
WILKES BARRE
PA
187027906
Practice Location Phone/Fax
| Phone: | 5708087920 |
| Fax: | 5708086006 |
Provider Mailing Location
1155 E MOUNTAIN BLVD
WILKES BARRE
PA
187027906
Provider Mailing Phone/Fax
| Phone: | 5708087920 |
| Fax: | 5708086006 |