Individual
MR. CLIVET GLENARD STOLL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
11 ARCHER AVE, MT VERNON, NY 10550-2201
(914) 665-2146
(914) 664-1470
Mailing address
11 ARCHER AVE, MT VERNON, NY 10550-2201
(914) 665-2146
(914) 664-1470
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
229941
NY
Other
Enumeration date
05/11/2007
Last updated
07/08/2007
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