Provider Information for 1134571607
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GINA KAY CLARKE
Sex: Female
NPI: 1134571607
Last Updated: 2023-12-28
Certification Date: 2023-12-28
Certification Date: 2023-12-28
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1134571607 | ||||||||||||
| Enumeration Date | 2016-07-08 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 540 MILL ST WARSAW, IL 62379-1731 United States Phone: 309-431-1982 | Fax: | ||||||||||||
| Primary Practice Address | 540 MILL ST WARSAW, IL 62379-1731 United States Phone: 217-617-6727 | Fax: | ||||||||||||
| Secondary Practice Address(es) | 905 CLARK ST | ||||||||||||
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