Provider Demographics
NPI:1205685310
Name:CLARK, KAMIA UNQUE (INDEPENDENT PROVIDER)
Entity type:Individual
Prefix:
First Name:KAMIA
Middle Name:UNQUE
Last Name:CLARK
Suffix:
Gender:F
Credentials:INDEPENDENT PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1769 TECUMSEH ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43607-4360
Mailing Address - Country:US
Mailing Address - Phone:419-283-8841
Mailing Address - Fax:
Practice Address - Street 1:1769 TECUMSEH ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43607-4360
Practice Address - Country:US
Practice Address - Phone:419-283-8841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker