Provider Demographics
NPI:1831489723
Name:CLARKE, ANTOINETTE NADINE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ANTOINETTE
Middle Name:NADINE
Last Name:CLARKE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 MANITOU AVE
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-2736
Mailing Address - Country:US
Mailing Address - Phone:845-891-5889
Mailing Address - Fax:
Practice Address - Street 1:22 MANITOU AVE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2736
Practice Address - Country:US
Practice Address - Phone:845-891-5889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7055753UPD164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse