Provider Demographics
NPI:1295872588
Name:CLARK, ANN LOUISE (ARNP, CNM)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:LOUISE
Last Name:CLARK
Suffix:
Gender:F
Credentials:ARNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:LANDSTUHL REGIONAL MEDICAL CENTER
Mailing Address - Street 2:CMR 402
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09180
Mailing Address - Country:US
Mailing Address - Phone:49637-186-8635
Mailing Address - Fax:49637-186-8557
Practice Address - Street 1:LANDSTUHL MEDICAL CENTER
Practice Address - Street 2:CMR 402
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09180
Practice Address - Country:US
Practice Address - Phone:49637-186-8635
Practice Address - Fax:49637-186-8557
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP3094162367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife