Individual
RAVEN CLAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5471 DR MARTIN LUTHER KING DR, SAINT LOUIS, MO 63112-4265
(314) 633-6363
Mailing address
11 JOYCE ELLEN LN, FERGUSON, MO 63135-2140
(614) 423-5243
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
113537A
MO
Other
Enumeration date
04/15/2020
Last updated
04/15/2020
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