Provider Demographics
NPI:1619505112
Name:CLARK, MARGI ANNE (RN)
Entity Type:Individual
Prefix:
First Name:MARGI
Middle Name:ANNE
Last Name:CLARK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 WELLS BRANCH PKWY APT 828
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728-7161
Mailing Address - Country:US
Mailing Address - Phone:512-785-1351
Mailing Address - Fax:
Practice Address - Street 1:1630 WELLS BRANCH PKWY APT 828
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78728-7161
Practice Address - Country:US
Practice Address - Phone:512-785-1351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX554059163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics