Individual
MR. SHENAN LARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
28 ASPEN ST. # 205, ANGEL FIRE, NM 87710
(505) 603-9282
Mailing address
PO BOX 1522, ANGEL FIRE, NM 87710-1522
(505) 603-9282
Taxonomy
Speciality
Code
Description
License number
State
146D00000X
Personal Emergency Response Attendant
—
—
172A00000X
Driver
—
—
347C00000X
Private Vehicle
Primary
—
—
Other
Enumeration date
04/01/2015
Last updated
04/01/2015
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