NPI 1972490258

Vontisha Shavron Clark

Practitioner Driver Williston, ND

Practice location

Address: 3315 2nd Ave E APT 102, Williston, ND 58801-2815
Phone: (701) 651-6625
Fax: (701) 651-6625

Registered specialties

Driver Primary

Other Service Providers Taxonomy 172A00000X Licence CLA806348 (ND)

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Registry record

NPI: 1972490258
Entity type: Individual
Sex (as registered): Female
NPI issued: 19 Jun 2025
Record last updated: 19 Jun 2025

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.