Provider Demographics
NPI:1750976759
Name:CLARKE, CAMARINE (LPN)
Entity type:Individual
Prefix:MRS
First Name:CAMARINE
Middle Name:
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 1:163 WESTRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-9232
Mailing Address - Country:US
Mailing Address - Phone:404-570-0670
Mailing Address - Fax:
Practice Address - Street 1:163 WESTRIDGE CIR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-9232
Practice Address - Country:US
Practice Address - Phone:404-570-0670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA093258164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty