Individual
MRS. JOANNE CLARKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ELECTROLOGIST
Contact information
Practice address
723 SE MAIN STREET, ROSEBURG, OR 97470-3938
(541) 760-8401
Mailing address
1183 NW RIVERFRONT DR, ROSEBURG, OR 97471-6168
Taxonomy
Speciality
Code
Description
License number
State
374700000X
Technician
Primary
BAP-E-10202403
OR
Other
Enumeration date
01/07/2020
Last updated
01/07/2020
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