Provider Demographics
NPI:1093036634
Name:CLARK, ESTHER ELAINE (LPN)
Entity Type:Individual
Prefix:MS
First Name:ESTHER
Middle Name:ELAINE
Last Name:CLARK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:ESTHER
Other - Middle Name:ELAINE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:229 GARDNERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NEW HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:10958-4425
Mailing Address - Country:US
Mailing Address - Phone:845-355-6262
Mailing Address - Fax:
Practice Address - Street 1:229 GARDNERVILLE RD
Practice Address - Street 2:
Practice Address - City:NEW HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:10958-4425
Practice Address - Country:US
Practice Address - Phone:845-355-6262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY279798-1251E00000X, 164W00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No251J00000XAgenciesNursing Care