Individual
DEVAN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
3540 N SNOW GOOSE DR, WASILLA, AK 99654-2505
(419) 961-3818
Mailing address
3540 N SNOW GOOSE DR, WASILLA, AK 99654-2505
(419) 961-3818
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
107485
AK
174400000X
Specialist
MT-21190
AZ
Other
Enumeration date
09/08/2016
Last updated
09/08/2016
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