Provider Demographics
NPI:1801542592
Name:CLARK, LINDA MARIE (RN)
Entity type:Individual
Prefix:MR
First Name:LINDA
Middle Name:MARIE
Last Name:CLARK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 SHARON CT
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-1730
Mailing Address - Country:US
Mailing Address - Phone:732-734-7406
Mailing Address - Fax:732-452-4133
Practice Address - Street 1:56 SHARON CT
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-1730
Practice Address - Country:US
Practice Address - Phone:732-734-7406
Practice Address - Fax:732-452-4133
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR13150400163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontologyGroup - Single Specialty