Individual
RACHEL LOUISE CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
781 GRAND CASINO BLVD, SHAWNEE, OK 74804-1005
(405) 964-5770
(405) 964-5788
Mailing address
781 GRAND CASINO BLVD, SHAWNEE, OK 74804-1005
(405) 964-5770
(405) 964-5788
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
60894
OK
Other
Enumeration date
09/29/2020
Last updated
09/29/2020
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