Provider Demographics
NPI:1194203281
Name:CLARK, TANYA (CMA)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:CLARK
Suffix:
Gender:F
Credentials:CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 WALKER ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04732-3429
Mailing Address - Country:US
Mailing Address - Phone:207-538-3700
Mailing Address - Fax:207-528-2595
Practice Address - Street 1:33 WALKER STREET
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:ME
Practice Address - Zip Code:04732
Practice Address - Country:US
Practice Address - Phone:207-538-3700
Practice Address - Fax:207-528-2595
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker