Clark, Illise

Clark, Illise is an individual health care provider with primary practice located at 8881 Schaeffer St , Mentor OH 44060-5035. She recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Clark, Illise can be contacted via phone (440) 255-9309.

Contact Information

Primary practice address
8881 Schaeffer St Mentor OH 44060-5035
Phone: (440) 255-9309
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X RN.371331 Ohio
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X APRN.CNP.0022454 Ohio

Profile Details

NPI number 1396004776
LBN Legal business name Clark, Illise
Credentials FNP-NP
Entity Individual
Sole proprietor 1 No
Enumeration date May 7th, 2012
Last updated May 12th, 2026 - about 6 months 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 1396004776 NPPES
Ohio MEDICAID 0268768

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