Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | CLA104278445 | OH |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | NP04721 | OH |
NPI | 1215103502 |
---|---|
Provider Name | Karen Louise Clancy |
First Address | Columbus, OH 43215 |
Second Address | Columbus, OH 43215 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2008 |
Last Update Date | 06/05/2008 |