Clark, Elise Diane

Clark, Elise Diane is an individual health care provider with primary practice located at 2875 W Elm St , Lima OH 45805-2510. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Clark, Elise Diane can be contacted via phone (419) 991-7805.

Contact Information

Primary practice address
2875 W Elm St Lima OH 45805-2510
Phone: (419) 991-7805
Fax: (419) 991-7862
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X NP06689 Ohio

Profile Details

NPI number 1184619595
LBN Legal business name Clark, Elise Diane
Credentials FNP BC
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 13th, 2005
Last updated Mar 29th, 2021 - about 3 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 1184619595 NPPES
Ohio Other 9934001 MEDICARE PTAN
Ohio MEDICAID 2360252 MEDICARE PTAN
Ohio Other 500023896 MEDICARE PTAN

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