Clark, Lisa Marie

Clark, Lisa Marie is an individual health care provider with primary practice located at 11100 Euclid Ave , Cleveland OH 44106-1716. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Anesthesiologist Assistant, which is considered as her primary health care specialty. Clark, Lisa Marie can be contacted via phone (216) 844-5583.

Contact Information

Primary practice address
11100 Euclid Ave Cleveland OH 44106-1716
Phone: (216) 844-5583
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Anesthesiologist Assistant 367H00000X 75000044A Indiana
Physician Assistants & Advanced Practice Nursing Providers / Anesthesiologist Assistant 367H00000X 1000-00543 North Carolina
Physician Assistants & Advanced Practice Nursing Providers / Anesthesiologist Assistant 367H00000X 67000102 Ohio

Profile Details

NPI number 1215998927
LBN Legal business name Clark, Lisa Marie
Credentials CAA
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 31st, 2006
Last updated Aug 18th, 2023 - about last year

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 1215998927 NPPES
North Carolina Other 185M9 BCBS
North Carolina MEDICAID 2438348 BCBS
North Carolina Other 377459 BCBS
North Carolina Other 1215998927 BCBS
North Carolina MEDICAID 1215998927 BCBS

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