MEDICARE: NANCY CLARK APRN

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	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	0327182304	NH
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	032718-23	NH

General Provider Information

NPI Number	:	1437132941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY CLARK APRN

Provider Business Mailing Address
First Line	:	PO BOX 2032
Second Line	:
City	:	CONCORD
State	:	NH
Zip	:	03302-2032
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 PLEASANT ST
Second Line	:
City	:	CONCORD
State	:	NH
Zip	:	03301-4006
Country	:	US
Telephone Number	:	844-524-6673
Fax Number	:

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

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	10/03/2018

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