Provider Demographics
NPI:1902352651
Name:CLARKE, FRANCES JANE
Entity Type:Individual
Prefix:MRS
First Name:FRANCES
Middle Name:JANE
Last Name:CLARKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77WEST 174 STREET
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453
Mailing Address - Country:US
Mailing Address - Phone:917-620-8922
Mailing Address - Fax:
Practice Address - Street 1:165 BROWN PL
Practice Address - Street 2:BX
Practice Address - City:BRONX
Practice Address - State:OH
Practice Address - Zip Code:10454
Practice Address - Country:US
Practice Address - Phone:718-292-4502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI992823291174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist