Individual
CAROL JEAN CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OA, LPN
Contact information
Practice address
1000 W 140TH ST, SUITE 201, BURNSVILLE, MN 55337-4480
(952) 808-3000
(952) 808-3001
Mailing address
4200 DAHLBERG DR, SUITE 300, GOLDEN VALLEY, MN 55422-4840
(952) 512-5600
(952) 512-5651
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L 12777-6
MN
Other
Enumeration date
02/14/2013
Last updated
02/14/2013
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