Williette Clark

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

1003182 Issued in DC

Practice address

9311 Willow Creek Dr
Apt F
Montgomery Village, MD 20886-0422

Phone

(240) 751-5779

NPI assigned

Mar 8, 2016

Last updated

Mar 8, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1457395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1457395200000",
    "number": "1174984934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9311 WILLOW CREEK DR",
            "address_2": "APT F",
            "city": "MONTGOMERY VILLAGE",
            "state": "MD",
            "postal_code": "208860422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9311 WILLOW CREEK DR",
            "address_2": "APT F",
            "city": "MONTGOMERY VILLAGE",
            "state": "MD",
            "postal_code": "208860422",
            "telephone_number": "240-751-5779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "WILLIETTE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-08",
        "last_updated": "2016-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "DC",
            "license": "1003182",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chinh N. Le. D.D.S. L.L.C.
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• Csaac, Inc.

• Licensed Practical Nurse in Montgomery Village, MD
• Providers in Montgomery Village, MD by specialty
• Licensed Practical Nurse in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.