Individual
GRACE J CLARKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5509 36TH AVE S, FARGO, ND 58104-5216
(267) 971-8143
Mailing address
5509 36TH AVE S, FARGO, ND 58104-5216
(267) 971-8143
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
831DPG
ND
Other
Enumeration date
09/14/2024
Last updated
09/14/2024
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