Provider Demographics
NPI:1790544807
Name:CLARK, LINDSEY MARIAH
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:MARIAH
Last Name:CLARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 MAIN ST E
Mailing Address - Street 2:
Mailing Address - City:MOHALL
Mailing Address - State:ND
Mailing Address - Zip Code:58761-4014
Mailing Address - Country:US
Mailing Address - Phone:701-857-8614
Mailing Address - Fax:
Practice Address - Street 1:315 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:KENMARE
Practice Address - State:ND
Practice Address - Zip Code:58746
Practice Address - Country:US
Practice Address - Phone:701-217-0192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant