Individual
STACEY MATLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
306 7TH AVE, CANDO, ND 58324-6500
(701) 370-3804
Mailing address
PO BOX 181, CANDO, ND 58324-0181
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
—
—
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Enumeration date
02/12/2024
Last updated
02/12/2024
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