Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | 026206 | OH |
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | APRN.CNP.026206 | OH |
NPI | 1568094530 |
---|---|
Provider Name | Lori Clark |
First Address | Medina, OH 44256-7765 |
Second Address | Elyria, OH 44035-5902 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2020 |
Last Update Date | 13/02/2020 |