Provider Demographics
NPI:1992195853
Name:CLARKE, PATRICIA TERESA (LPN)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:TERESA
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 1:5 LINCOLN TERRACE
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550
Mailing Address - Country:US
Mailing Address - Phone:845-926-6863
Mailing Address - Fax:
Practice Address - Street 1:508 AIRPORT EXECUTIVE PARK
Practice Address - Street 2:INTERIM HEALTH CARE
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954
Practice Address - Country:US
Practice Address - Phone:845-425-2655
Practice Address - Fax:845-425-2995
Is Sole Proprietor?:No
Enumeration Date:2015-01-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY259778-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse