Marlo Clark
Individual provider Active NPI Driver · Durham, NC
NPI 1699517243 · NPPES record last updated Jun 13, 2024
Key facts
- NPI
- 1699517243
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- Practice address
- 711 Linwood Ave
Durham, NC 27701-4429 - Phone
- (919) 225-1460
- NPI assigned
- Jun 12, 2024
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | Yes | ||
| Counselor | 101Y00000X |
Addresses
Primary practice location
711 Linwood Ave
Durham, NC 27701-4429
Mailing address
711 Linwood Ave
Durham, NC 27701-4429
Other providers in Durham, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 13, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.