Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 000058 | CT |
NPI | 1013909050 |
---|---|
Provider Name | Terri Patrice Clark |
First Address | Hamden, CT 06518-2512 |
Second Address | New Haven, CT 06519-1703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2005 |
Last Update Date | 08/07/2007 |