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General NPI Number Information
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NPI Number | 1043638315
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Entity Type | Individual
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Provider Name | LINDSEY NICOLE CLARK M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/02/2014
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Last Update Date | 08/05/2024
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Provider Practice Location Address
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Address Line | 3811 SPRING ST # 201
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City | MOUNT PLEASANT
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State | WI
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Zip | 53405-1667
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Country | US
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Telephone | 262-687-5850
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Fax |
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Provider Business Mailing Address
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Address Line | 3811 SPRING ST # 201
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City | MOUNT PLEASANT
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State | WI
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Zip | 53405-1667
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Country | US
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Telephone | 812-212-4614
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 61458
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 64427-20
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License Number State | WI
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