Nicole Clark, HAIR LOSS SPECIALIST
NPI #1386106375 in Long Beach, Mississippi
Provider Information
- NPI Number
- 1386106375
- Entity Type
- Individual
- Name
- Nicole Clark, HAIR LOSS SPECIALIST
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Prosthetist
- Credential
- HAIR LOSS SPECIALIST
- Enumeration Date
- Apr 1, 2019
- Last Updated
- Apr 1, 2019
Practice Location
- Address
- 100 N BURKE AVE
- City
- Long Beach
- State
- Mississippi
- ZIP Code
- 39560-4605
- Phone
- (228) 234-1658
Specialties & Taxonomy Codes
| Specialty |
|---|
| Prosthetist |
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