Provider Demographics
NPI:1538213061
Name:CLARK-LAMAR, MINNIE ELIZABETH (CRNA)
Entity type:Individual
Prefix:MS
First Name:MINNIE
Middle Name:ELIZABETH
Last Name:CLARK-LAMAR
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:12322 SHADETREE LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-2834
Mailing Address - Country:US
Mailing Address - Phone:301-604-4945
Mailing Address - Fax:301-604-4945
Practice Address - Street 1:12322 SHADETREE LN
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-2834
Practice Address - Country:US
Practice Address - Phone:301-807-1488
Practice Address - Fax:301-604-4945
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR125892367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered