MEDICARE: MRS. HANNAH CLARK ST. JEOR NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	5899	MN
2	363L00000X	Nurse Practitioner	5014686	NC

General Provider Information

NPI Number	:	1023598059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HANNAH CLARK ST. JEOR NP-C

Provider Business Mailing Address
First Line	:	100 KIMEL FOREST DR
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-6074
Country	:	US
Telephone Number	:	336-716-2255
Fax Number	:

Provider Business Practice Location Address
First Line	:	MEDICAL CENTER BLVD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27157-0001
Country	:	US
Telephone Number	:	336-716-4171
Fax Number	:	336-716-8759

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2018
Last Update Date	:	02/25/2026

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