Individual
MS. THORA C. MARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
520 W SANTA MONICA AVE, DEDEDO, GU 96929-5286
(671) 635-7400
Mailing address
PO BOX 5152, MANGILAO, GU 96923-5152
(671) 734-6275
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RX0487
GU
363LF0000X
Family Nurse Practitioner
Primary
NP0169
GU
Other
Enumeration date
09/28/2017
Last updated
02/16/2021
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