Healthcare Provider Details

I. General information

NPI: 1366183709
Provider Name (Legal Business Name): DR. NATALIE CLARK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATALIE CLARK

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 NEW WAVERLY PL
CARY NC
27518-7412
US

IV. Provider business mailing address

1816 N CALIFORNIA AVE APT 3S
CHICAGO IL
60647-0023
US

V. Phone/Fax

Practice location:
  • Phone: 919-467-5941
  • Fax:
Mailing address:
  • Phone: 704-302-5473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number125.080249
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2026-02319
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: