Provider Demographics
NPI:1295015550
Name:WOO-CLARK, ALICIA EMILY (CNS-BC)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:EMILY
Last Name:WOO-CLARK
Suffix:
Gender:F
Credentials:CNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1299 INDUSTRIAL PKWY N
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-6367
Mailing Address - Country:US
Mailing Address - Phone:330-225-6468
Mailing Address - Fax:330-225-6534
Practice Address - Street 1:1299 INDUSTRIAL PKWY N
Practice Address - Street 2:SUITE 110
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-6367
Practice Address - Country:US
Practice Address - Phone:330-225-6468
Practice Address - Fax:330-225-6534
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH321964163W00000X
OHCOA 11235-NS364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse