Individual
MS. NICOLLETTE SHAUTRIA CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
940 NEAL PL, MONTICELLO, MS 39654-7003
(601) 522-9025
Mailing address
940 NEAL PL, MONTICELLO, MS 39654-7003
(601) 522-9025
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
MS
Other
Enumeration date
08/23/2019
Last updated
08/23/2019
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