Provider Demographics
NPI:1194213256
Name:CLARK-GEIGER, CAROL JEAN (DNP ACNPC-AG)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:JEAN
Last Name:CLARK-GEIGER
Suffix:
Gender:F
Credentials:DNP ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4060 POLI RD
Mailing Address - Street 2:
Mailing Address - City:ORTONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48462-9238
Mailing Address - Country:US
Mailing Address - Phone:248-561-5849
Mailing Address - Fax:
Practice Address - Street 1:4100 S SAGINAW ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-2683
Practice Address - Country:US
Practice Address - Phone:810-230-4720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704220753363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care