Clark, Maryanne C

Clark, Maryanne C is an individual health care provider with primary practice located at 2715 N 3Rd St , Phoenix AZ 85004-1106. 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 / Psychiatric/Mental Health. Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health is her primary health care specialty. Clark, Maryanne C can be contacted via phone (602) 264-4331.

Contact Information

Primary practice address
2715 N 3Rd St Phoenix AZ 85004-1106
Phone: (602) 264-4331
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X AP11153 Arizona
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X AP11154 Arizona

Profile Details

NPI number 1982685954
LBN Legal business name Clark, Maryanne C
Credentials PMHNP
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 8th, 2005
Last updated Feb 19th, 2019 - about 6 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 1982685954 NPPES
Arizona MEDICAID 376867

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