| Doctor Name: | MR. MICHAEL ANTHONY CLARK |
| NPI Number: | 1255478111 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | R.N. |
| License Number: | RN 199634 |
| Business Practice Address: | 10535 Hospital Way Mather, CA - 956554200 |
| Business Phone Number: | 9163665410 |
| Business Fax Number: | |
| Mailing Address: | 1780 Creekside Dr, Apt: 2424 FOLSOM |
| State: | CA |
| Postal Code: | 956303838 |
| Phone Number: | 5136385232 |
| Fax Number: | |
| NPI Enumeration Date: | 01/31/2007 |
| NPI Last Update Date: | 06/29/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WC0400X |
| License Number: | RN 199634 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | OH |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Case Management |
| Taxonomy Definition: | |