Provider Demographics
NPI:1003915414
Name:CLARK, SANDRA SINGLETON (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:SINGLETON
Last Name:CLARK
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 JOHNS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28716-5583
Mailing Address - Country:US
Mailing Address - Phone:828-235-9188
Mailing Address - Fax:
Practice Address - Street 1:157 PARAGON PKWY
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-9463
Practice Address - Country:US
Practice Address - Phone:828-452-6675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC053719163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse