Provider Demographics
NPI:1104908060
Name:CLARK, JO ANN D (RN)
Entity type:Individual
Prefix:
First Name:JO ANN
Middle Name:D
Last Name:CLARK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 454 BX 2078
Mailing Address - Street 2:USAHC KATTERBACH
Mailing Address - City:KATTERBACH
Mailing Address - State:GE
Mailing Address - Zip Code:09250
Mailing Address - Country:DE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CMR 454 BX 2078
Practice Address - Street 2:USAHC KATTERBACH
Practice Address - City:KATTERBACH
Practice Address - State:GE
Practice Address - Zip Code:09250
Practice Address - Country:DE
Practice Address - Phone:01149980-283-3229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28150675A163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical