NPI 1083110225

Nicole C. Clark, DO

Practitioner Family Medicine Physician Lebanon, IN

Practice location

Address: 2705 N Lebanon St STE 300, Lebanon, IN 46052-8622
Phone: (765) 485-8649
Fax: (765) 485-8650
Mailing address: 2605 N Lebanon St, Lebanon, IN 46052-1476

Registered specialties

Family Medicine Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207Q00000X Licence 02006481A (IN)

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Registry record

NPI: 1083110225
Entity type: Individual
Sex (as registered): Female
NPI issued: 5 Apr 2018
Record last updated: 10 Oct 2023

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.