Provider Demographics
NPI:1093303844
Name:CLARK, JUDY REGINA
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:REGINA
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3820 2ND ST SE APT 101
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-3007
Mailing Address - Country:US
Mailing Address - Phone:202-246-8222
Mailing Address - Fax:
Practice Address - Street 1:206 WAYNE PL SE APT G2
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-3063
Practice Address - Country:US
Practice Address - Phone:202-574-0864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion