Provider Demographics
NPI:1073875704
Name:CLARK, SHEILA BRIDGET (SHEILA CLARK)
Entity type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:BRIDGET
Last Name:CLARK
Suffix:
Gender:F
Credentials:SHEILA CLARK
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:BRIDGET
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:204 E WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:PERKASIE
Mailing Address - State:PA
Mailing Address - Zip Code:18944-1636
Mailing Address - Country:US
Mailing Address - Phone:267-664-1420
Mailing Address - Fax:
Practice Address - Street 1:204 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:PERKASIE
Practice Address - State:PA
Practice Address - Zip Code:18944-1636
Practice Address - Country:US
Practice Address - Phone:267-664-1420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN514584L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse