Donald Lee Clark III, FNP-BC
Nurse Practitioner, Family in Granite City, IL. Individual provider (NPI-1).
NPI number1366090573
StatusActive
Last updated in NPPESAug 30, 2019
Details
- NPI
- 1366090573
- Entity type
- Individual (NPI-1)
- Name
- Donald Lee Clark III
- Credential
- FNP-BC
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Aug 30, 2019
- Last updated
- Aug 30, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 209019719 | IL | Yes |
Practice location
2100 Madison AveGranite City, IL 62040-4713
Phone 618-798-3000
Mailing address
8308 Burlington DrTroy, IL 62294-4003
Phone 618-402-3946
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All 12 Family Nurse Practitioner providers in Granite City · All 486 providers in Granite City
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