| Doctor Name: | MARY THERESA MCGUIRE CLARK |
| NPI Number: | 1265836928 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CNP |
| License Number: | F1014276 |
| Business Practice Address: | 150 Emerson Ave E West Saint Paul, MN - 551182535 |
| Business Phone Number: | 6512411800 |
| Business Fax Number: | |
| Mailing Address: | 5439 Upper 147th St W, APPLE VALLEY |
| State: | MN |
| Postal Code: | 551246665 |
| Phone Number: | 6127308117 |
| Fax Number: | |
| NPI Enumeration Date: | 10/09/2014 |
| NPI Last Update Date: | 10/09/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | F1014276 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |