Clark, Mary Ellen

Clark, Mary Ellen is an individual health care provider with primary practice located at 90 Hope Dr Bldg 6000 , Mountain Home Afb ID 83648-1062. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Family, Physician Assistants & Advanced Practice Nursing Providers / Primary Care. Physician Assistants & Advanced Practice Nursing Providers / Primary Care is her primary health care specialty. Clark, Mary Ellen can be contacted via phone (208) 828-7635.

Contact Information

Primary practice address
90 Hope Dr Bldg 6000 Mountain Home Afb ID 83648-1062
Phone: (208) 828-7635
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X CNP-02460 New Mexico
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 201250210NP Oregon
Physician Assistants & Advanced Practice Nursing Providers / Primary Care 363LP2300X 66049 Idaho

Profile Details

NPI number 1891031621
LBN Legal business name Clark, Mary Ellen
Credentials Certified Family Nurse Practitioner (CFNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 26th, 2012
Last updated Jul 16th, 2021 - about 4 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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