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Contact Information

URSULA L CLARK
4700 ROLLING PINE DR APT D25
LAKE PARK, GA31636-4935
 Phone: 305-877-6401
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Contractor

171W00000X
Indicates primary specialty

NPI Profile & details for URSULA L CLARK · (Female)

NPI Number 1710562129
Status Active
Credentials
Entity Individual
Enumeration date 03/17/2021
Last updated 03/17/2021 - About 5 years ago
Sole proprietor 1 No
Identifiers Not Available
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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