Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | 4704092855 | MI |
NPI | 1104970151 |
---|---|
Provider Name | Mrs. Sharon Rose Clark |
First Address | Centreville, MI 49032-9656 |
Second Address | Sturgis, MI 49091-2371 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4565978 | (05) | MI |