Individual
BROCK S CLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN, CRNA
Contact information
Practice address
1101 9TH ST N, VIRGINIA, MN 55792-2329
(218) 741-0150
Mailing address
1702 UNIVERSITY DR S, FARGO, ND 58103-4940
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
2432
MN
Other
Enumeration date
12/05/2019
Last updated
01/13/2020
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