Provider Demographics
NPI:1154636991
Name:CLARKE, NOVLETTE G (LPN)
Entity Type:Individual
Prefix:MISS
First Name:NOVLETTE
Middle Name:G
Last Name:CLARKE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 E 230TH ST
Mailing Address - Street 2:APT #2
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-4158
Mailing Address - Country:US
Mailing Address - Phone:347-323-8895
Mailing Address - Fax:
Practice Address - Street 1:724 E 230TH ST
Practice Address - Street 2:APT #2
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-4158
Practice Address - Country:US
Practice Address - Phone:347-323-8895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY28715-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse