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MRS. KOLU S. BAYSAH CLARK

Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner Primary Care

Provider NPI: 1336535624

Provider Information:
MRS. KOLU S. BAYSAH CLARK 
Gender: F
Not Sole Proprietor

Practice Location:
1 HARVARD RD  SHIRLEY, MA 01464-2434 US
Tel: 978-425-4341  Fax: --

Business Mailing Address:
149 POMONA AVE  PROVIDENCE, RI 02908-5123 US
Tel: 401-585-5864  Fax: --

NPI Information:
NPI: 1336535624
Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N363LP2300XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
Primary Care
RIAPRN00086
Y363LP2300XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
MARN2269378

Other Provider Identifiers:

IssuerNumberStateType



American Medical Association 2012 taxonomy code information

Code: 363LP2300X

Type:

Classification:



Definition:



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