Clark, Angelique

Clark, Angelique is an sole proprietor health care provider with primary practice located at 600 Pleasant Avenue , Park Rapids MN 56470. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer, which is considered as her primary health care specialty. Clark, Angelique can be contacted via phone (218) 616-3019.

Contact Information

Primary practice address
600 Pleasant Avenue Park Rapids MN 56470
Phone: (218) 616-3019
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer 2255A2300X 1472 Minnesota

Profile Details

NPI number 1659719938
LBN Legal business name Clark, Angelique
Credentials Athletic Trainer, Certified (ATC)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jun 10th, 2013
Last updated Jun 10th, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1659719938 NPPES
Minnesota MEDICAID 2255A2300X
Minnesota Other 2255A2300X

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