Provider Demographics
NPI:1932410867
Name:CLARK, ASHLYNNE HARRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHLYNNE
Middle Name:HARRIS
Last Name:CLARK
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:202 10TH ST SE STE 270
Practice Address - Street 2:C/O PCI MEDICAL PAVILLION
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2414
Practice Address - Country:US
Practice Address - Phone:319-294-4319
Practice Address - Fax:319-394-4298
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2022-12-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IAMD-42907207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery