| Doctor Name: | MRS. JIMMIE SUE CLARK |
| NPI Number: | 1780865485 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | R.N., P.H.N. |
| License Number: | 692825 |
| Business Practice Address: | 80 Highland Ave San Martin, CA - 950469504 |
| Business Phone Number: | 4086831232 |
| Business Fax Number: | 4086834953 |
| Mailing Address: | 80 Highland Ave, SAN MARTIN |
| State: | CA |
| Postal Code: | 950469504 |
| Phone Number: | 4086831232 |
| Fax Number: | 4086834953 |
| NPI Enumeration Date: | 11/21/2007 |
| NPI Last Update Date: | 12/18/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WC0400X |
| License Number: | 692825 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Case Management |
| Taxonomy Definition: | |