Individual
VONTISHA SHAVRON CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3315 2ND AVE E APT 102, WILLISTON, ND 58801-2815
(701) 651-6625
(701) 651-6625
Mailing address
3315 2ND AVE E APT 102, WILLISTON, ND 58801-2815
(701) 651-6625
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
CLA806348
ND
Other
Enumeration date
06/19/2025
Last updated
06/19/2025
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