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NPI Code Detail

MEDICARE: VIOLET CLARKE APN

MEDICARE: VIOLET CLARKE APN
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
1363LF0000XFamily Nurse Practitioner507077TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1507077OTHERTXLICENSE

General Provider Information

NPI Number : 1841482205
Entity Type Code : Individual
Provider Name (Legal Business Name) : VIOLET CLARKE APN
Provider Business Mailing Address
First Line : 161 WASHINGTON ST
Second Line : EIGHT TOWER BRIDGE, SUITE 1400
City : CONSHOHOCKEN
State : PA
Zip : 19428-2083
Country : US
Telephone Number : 866-825-3227
Fax Number : 484-450-2617
Provider Business Practice Location Address
First Line : 6768 HIGHWAY 6 S
Second Line :
City : HOUSTON
State : TX
Zip : 77083-1512
Country : US
Telephone Number : 866-825-3227
Fax Number : 484-450-2617
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2007
Last Update Date : 08/09/2007

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