Doctor Name: | MRS. RANDI CLARKE |
NPI Number: | 1003149618 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | F3052261 |
Business Practice Address: | 300 Community Dr Manhasset, NY - 110303816 |
Business Phone Number: | 5164104497 |
Business Fax Number: | |
Mailing Address: | 1483 Beech Ln, EAST MEADOW |
State: | NY |
Postal Code: | 115543706 |
Phone Number: | 5164104497 |
Fax Number: | |
NPI Enumeration Date: | 09/14/2009 |
NPI Last Update Date: | 09/14/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2200X |
License Number: | F3052261 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Adult Health |
Taxonomy Definition: |