MS. Theresa Carlisle Clark, REGISTERED NURSE

NPI #1003056383 in Phenix City, Alabama

Provider Information

NPI Number: 1003056383
Entity Type: Individual
Name: MS. Theresa Carlisle Clark, REGISTERED NURSE
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Registered Nurse
Credential: REGISTERED NURSE
Enumeration Date: Feb 26, 2009
Last Updated: Feb 26, 2009

Practice Location

Address: 1900 CARRIAGE DR
City: Phenix City
State: Alabama
ZIP Code: 36867-2116
Phone: (706) 289-9327

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Registered Nurse	163W00000X	Primary

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