| Doctor Name: | MS. ZENOBIA CLARK |
| NPI Number: | 1255719399 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP-C |
| License Number: | 209.012335 |
| Business Practice Address: | 17850 Kedzie Ave Ste 2200 Hazel Crest, IL - 604292056 |
| Business Phone Number: | 7087999500 |
| Business Fax Number: | 7087999555 |
| Mailing Address: | 3442 218th Pl, MATTESON |
| State: | IL |
| Postal Code: | 604432770 |
| Phone Number: | 7087248498 |
| Fax Number: | |
| NPI Enumeration Date: | 05/08/2015 |
| NPI Last Update Date: | 05/08/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 209.012335 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |