Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | SP012941 | PA |
N | 363LG0600X | Nurse Practitioner - Gerontology | SP012941 | PA |
NPI | 1013340462 |
---|---|
Provider Name | Dr. Amanda Lynn Clark |
First Address | Mars, PA 16046-2430 |
Second Address | Mars, PA 16046-2430 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2013 |
Last Update Date | 20/08/2013 |