Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 5015199 | NC |
NPI | 1043983489 |
---|---|
Provider Name | Jacqueline Clarke |
First Address | Greensboro, NC 27405-3391 |
Second Address | Greensboro, NC 27405-3391 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2021 |
Last Update Date | 02/11/2021 |