Provider Demographics
NPI:1356747471
Name:CLARKE, MARKIND (LPN)
Entity type:Individual
Prefix:
First Name:MARKIND
Middle Name:
Last Name:CLARKE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 VAN DUZER ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-2066
Mailing Address - Country:US
Mailing Address - Phone:718-273-9339
Mailing Address - Fax:
Practice Address - Street 1:516 VAN DUZER ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-2066
Practice Address - Country:US
Practice Address - Phone:718-273-9339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY318412-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY931182622OtherGHI