Provider Demographics
NPI:1184861551
Name:CLARKE, ANNE MARIE
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:CLARKE
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 1:2497 GRAND AVE
Mailing Address - Street 2:APT 3 A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-5148
Mailing Address - Country:US
Mailing Address - Phone:718-924-8020
Mailing Address - Fax:
Practice Address - Street 1:2497 GRAND AVE
Practice Address - Street 2:APT 3 A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-5148
Practice Address - Country:US
Practice Address - Phone:718-924-8020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY294368164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse