Debra Ann Clark, RN
Individual provider Active NPI Pediatric Registered Nurse · Granite City, IL
NPI 1508079328 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1508079328
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Registered Nurse 163WP0200X
- Practice address
- 2044 Madison Ave
Suite G7
Granite City, IL 62040-4641 - Phone
- (618) 451-6685
- Fax
- (618) 451-7292
- NPI assigned
- May 8, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 041291393 | IL | MD | Pediatric Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Registered Nurse | 163WP0200X | IL | Yes |
Addresses
Primary practice location
2044 Madison Ave
Suite G7
Granite City, IL 62040-4641
Mailing address
2044 Madison Ave
Suite G7
Granite City, IL 62040-4641
Phone (618) 451-6685
Other providers in Granite City, IL
- Children'S Home and Aid
- Cescelli Paige Childs
- Stacey L Choat
- CHR-Ash Inc
- City of Granite City
- Donald Lee Clark III
- Janel L. Clark
- Clarkson Optometry Illinois PC
- Clarkson Optometry Illinois, P.C.
- Elizabeth Cline
All providers in Granite City, IL · Pediatric Registered Nurse in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.