Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1063099380 |
---|---|
Provider Name | Karolina Ostapkiewicz Clark |
First Address | Raleigh, NC 27604-3659 |
Second Address | Raleigh, NC 27604-3659 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2021 |
Last Update Date | 24/03/2021 |