Organization
CARMEN C CLELLAND & LAURA A CLELLAND
Active
Other names
DiabeteSource
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA A CLELLAND (OWNER)
(928) 289-2778
Entity
Organization
Contact information
Practice address
207 N WILLIAMSON AVE, WINSLOW, AZ 86047-3719
(928) 289-2778
(928) 289-6777
Mailing address
207 N WILLIAMSON AVE, WINSLOW, AZ 86047-3719
(928) 289-2778
(928) 289-6777
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
1169830001
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
429771
—
AZ
Enumeration date
07/10/2006
Last updated
07/10/2008
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