| Doctor Name: | MRS. JENNA MARIE CLARK |
| NPI Number: | 1144687492 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN, BSN, IBCLC |
| License Number: | RN 343251 L-88563 |
| Business Practice Address: | 7611 Peterson Rd Conover, OH - 453179721 |
| Business Phone Number: | 9378755283 |
| Business Fax Number: | |
| Mailing Address: | 7611 Peterson Rd, CONOVER |
| State: | OH |
| Postal Code: | 453179721 |
| Phone Number: | 9378755283 |
| Fax Number: | |
| NPI Enumeration Date: | 01/18/2016 |
| NPI Last Update Date: | 01/18/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WL0100X |
| License Number: | RN 343251 L-88563 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Lactation Consultant |
| Taxonomy Definition: | |