Provider Demographics
NPI:1205206265
Name:CLARK, MALARIE
Entity Type:Individual
Prefix:
First Name:MALARIE
Middle Name:
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 1:6 S BELFAST RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:ME
Mailing Address - Zip Code:04363-3416
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6 S BELFAST RD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:ME
Practice Address - Zip Code:04363-3416
Practice Address - Country:US
Practice Address - Phone:207-240-2233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-03
Last Update Date:2015-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN63457163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse