Provider Demographics
NPI:1477376358
Name:CLARK, TEMIKA D
Entity type:Individual
Prefix:
First Name:TEMIKA
Middle Name:D
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6559 HIL MAR DR APT 202
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-4130
Mailing Address - Country:US
Mailing Address - Phone:202-210-5993
Mailing Address - Fax:
Practice Address - Street 1:6559 HIL MAR DR APT 202
Practice Address - Street 2:
Practice Address - City:DISTRICT HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20747-4130
Practice Address - Country:US
Practice Address - Phone:202-210-5993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant