NPI 1104211655

Shenan Lark

Practitioner Private Vehicle Angel Fire, NM

Practice location

Address: 28 Aspen St. # 205, Angel Fire, NM 87710
Phone: (505) 603-9282
Mailing address: PO Box 1522, Angel Fire, NM 87710-1522

Registered specialties (3)

Private Vehicle Primary

Transportation Services Taxonomy 347C00000X

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Personal Emergency Response Attendant

Emergency Medical Service Providers Taxonomy 146D00000X

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Driver

Other Service Providers Taxonomy 172A00000X

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Registry record

NPI: 1104211655
Entity type: Individual
Sex (as registered): Male
NPI issued: 1 Apr 2015
Record last updated: 1 Apr 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.