| Doctor Name: | MRS. SUSAN LOUISE CLARK |
| NPI Number: | 1043525025 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | 4704201015 |
| Business Practice Address: | 5701 Bow Pointe Dr Suite 225 Clarkston, MI - 483463198 |
| Business Phone Number: | 2483848300 |
| Business Fax Number: | 2483848309 |
| Mailing Address: | 5701 Bow Pointe Dr, Suite 225 CLARKSTON |
| State: | MI |
| Postal Code: | 483463198 |
| Phone Number: | 2483848300 |
| Fax Number: | 2483848309 |
| NPI Enumeration Date: | 08/13/2010 |
| NPI Last Update Date: | 08/13/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 4704201015 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |