MEDICARE: MS. LAUREN E CLARK RN

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	163WW0101X	Ambulatory Women's Health Care Registered Nurse	485580	NY
2	171M00000X	Case Manager/Care Coordinator

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356587794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAUREN E CLARK RN

Provider Business Mailing Address
First Line	:	325 COLUMBIA ST STE 100
Second Line	:
City	:	HUDSON
State	:	NY
Zip	:	12534-1913
Country	:	US
Telephone Number	:	518-828-4278
Fax Number	:	518-672-0673

Provider Business Practice Location Address
First Line	:	325 COLUMBIA ST STE 100
Second Line	:
City	:	HUDSON
State	:	NY
Zip	:	12534-1913
Country	:	US
Telephone Number	:	518-828-4278
Fax Number	:	518-671-6738

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

Provider Enumeration Date	:	01/06/2009
Last Update Date	:	08/27/2024

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