Individual
ANGELIQUE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
600 PLEASANT AVENUE, PARK RAPIDS, MN 56470
(218) 616-3019
Mailing address
600 PLEASANT AVE S, PARK RAPIDS, MN 56470-1431
(218) 616-3019
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1472
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2255A2300X
PRIVATE INSURANCE
MN
05
—
2255A2300X
—
MN
Enumeration date
06/10/2013
Last updated
06/10/2013
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