Individual
ALISHA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3907 ELMONTE CT, INDIANAPOLIS, IN 46226-5536
(602) 814-7212
Mailing address
3907 ELMONTE CT, INDIANAPOLIS, IN 46226-5536
(602) 814-7212
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
843176537
—
IN
Enumeration date
09/26/2019
Last updated
09/26/2019
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